title: Impact of Abuse on Adjustment and Chronic Pain Disability: A Structural Equation Model.
abstract: OBJECTIVE
  Sexual abuse, state and trait psychosocial factors, pain intensity, and pain-related disability have been shown to be correlated among individuals with chronic pain. However, the interacting relationships among these factors are poorly understood. The current study aims to test model which examines the effect of abuse, state and trait psychosocial factors, and pain intensity on pain-related disability among individuals with chronic pain.
  
  
  METHODS
  In total, 229 participants diagnosed with chronic pain were recruited from a specialist chronic pain hospital in London, Ontario. Participants completed self-report measures related to sexual abuse history, pain intensity, personality (anxiety sensitivity, experiential avoidance, perfectionism), and adjustment (depression, anxiety, disability, maladaptive worrying). A path analysis was used to test the relationship among these variables.
  
  
  RESULTS
  The model provided a close fit to the data (χ21=17.02; P=0.71; root-mean-square error of approximation=0.00; normal fit index=0.97; comparative fit index=1.0). The model demonstrates the direct and indirect effects of childhood sexual abuse on state and trait psychosocial factors among individuals with chronic pain. Pain anxiety, maladaptive worrying, and pain intensity were the main determinants of pain-related disability.
  
  
  CONCLUSIONS
  The current model has important implications in understanding the interplay of factors involved in adjustment of individuals with chronic pain. Sexual abuse did not have a direct effect on pain-related disability. However, indirect effects through other psychosocial factors were demonstrated.
authors.affiliation: *Department of Health and Rehabilitation Sciences, Western University §Department of Psychology ∥Department of Physical Medicine †Lawson Health Research Institute ‡Parkwood Institute Research, Parkwood Institute, St. Joseph's Health Care London, London, ON, Canada.
authors.forename: Swati
authors.initials: S
authors.lastname: Mehta
authors.forename: Danielle
authors.initials: D
authors.lastname: Rice
authors.forename: Alan
authors.initials: A
authors.lastname: Chan
authors.forename: Allan P
authors.initials: AP
authors.lastname: Shapiro
authors.forename: Keith
authors.initials: K
authors.lastname: Sequeira
authors.forename: Robert W
authors.initials: RW
authors.lastname: Teasell
mesh_terms: D058443:Catastrophization; D059350:Chronic Pain / Q000523:psychology*; D019548:Crime Victims / Q000523:psychology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010551:Personality; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D012742:Sex Offenses / Q000523:psychology; D012917:Social Adjustment