title: Chronic pain and violent ideation: testing a model of patient violence.
abstract: OBJECTIVE
  Physicians are at risk of patient-perpetrated violence. The objective of this study was to test a clinical model of patient violence, which had been developed previously by Fishbain and colleagues. The developers of this model believed that it would be associated with increased risk of violence in pain patients.
  
  
  METHODS
  Hypotheses generated by the model were tested using manova and chi-square procedures.
  
  
  METHODS
  A total of 527 subjects for this study were patients obtained from 90 medical facilities in 30 U.S. states.
  
  
  METHODS
  All subjects were patients being treated for injury and nonmalignant pain. All of the subjects were adults, ranging in age from 18 to 65 years, and were able to read at the sixth-grade level. The demographics of the sample approximated U.S. Census data for race, education, age, and gender.
  
  
  RESULTS
  The results included findings that violent ideation was associated with higher levels of physical difficulties, including pain (P = 0.01), problems with functioning (P = 0.0003), and somatic complaints (P = 0.0001). Significant psychosocial variables included hostility (P < 0.0001), dependency (P < 0.0001), substance abuse (P < 0.0001), litigation (P < 0.001), and a lack of trust in the physician (P < 0.001).
  
  
  CONCLUSIONS
  Using the Battery for Health Improvement 2 as a measure, the findings of this study consistently supported the Fishbain Model of violence risk, and also reinforced the need for psychological assessment and management when working with chronic pain patients. Suggestions for intervention were also offered, but further research will be necessary to see whether these interventions are effective in decreasing patient violence.
authors: Health Psychology Associates, Greeley, CO 80634, USA. daniel.bruns@healthpsych.com
authors: Daniel
authors: D
authors: Bruns
authors: John M
authors: JM
authors: Disorbio
authors: Richard
authors: R
authors: Hanks
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002908:Chronic Disease; D005260:Female; D006791:Hostility; D006801:Humans; D007603:Jurisprudence; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010146:Pain / Q000209:etiology / Q000523:psychology*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011237:Predictive Value of Tests; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology; D014754:Violence / Q000523:psychology*; D014947:Wounds and Injuries / Q000150:complications