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Childhood Abuse, Depression, and Chronic Pain
Abstract
To investigate the relationships among history of childhood abuse, type of pain, and depression.
Survey, consecutive sample, correlational.
An interdisciplinary pain-management center in a rehabilitation hospital.
The participants were 201 consecutive patients with chronic pain complaints, 68% women, mean age 38 years, of whom 28% complained of pain in more than three major sites, 26% had low back pain, 19% had craniofacial pain, and 25% had pain in other regions.
Beck Depression Inventory, Childhood History recorded presence or absence of abuse, age of onset, age when abuse was acknowledged, duration and frequency of abuse, relationship of abuser to the participant. Pain type was classified by IASP.
Patients with history of both sexual and physical abuse in childhood had more depression. The differences among abuse groups was significant (p < 0.03). The impact of childhood abuse and type of pain on depression was tested by a two-factor analysis of variance. The influence of childhood abuse was significant (p < 0.04), whereas the influence of type of pain (p < 0.76) and the interaction between type of pain and childhood abuse (p < 0.40) were not significant.
There is a positive, significant relationship between depression and history of childhood sexual and physical abuse. The influence of type of pain on depression was not significant. Prevailing research explained depression as an expected, natural consequence of chronic pain. Our research suggests that the relationship between chronic pain and depression may be attributable in part to childhood abuse history.
... However, previous studies in literature (As-Sanie et al., 2014;Goldberg, 1994;Sachs-Ericsson et al., 2007) have not documented ELS as a primary factor for comorbidity between depression and chronic pain. However, this is the first article that shows EN as a risk factor for comorbidity of depression and chronic pain. ...
... The third limitation of this study is that subjects that composed the group depression and chronic pain presented different kinds of pain. Although some studies showed that different kinds of pain mixed in the same sample do not cause a considerable interference in the main result (Goldberg, 1994). ...
It is estimated that comorbidity between depression and chronic pain reaches more than half of the depressed adult patients around the world. Evidence indicates that some stressors, such as early-life stress (ELS), mediate the co-occurrence of depression and chronic pain. This study aimed to assess whether ELS or any of its subtypes could be considered as risk factors for comorbidity between depression and chronic pain. For this purpose, 44 patients in depressive episode were evaluated, in which 22 were diagnosed with depression and chronic pain, and the other 22 patients were diagnosed with depression but without chronic pain. Results had shown that ELS occurrence is more significant among depressive patients with chronic pain compared with those without pain. When subtypes of ELS were evaluated, the group of depressive patients with pain showed significantly higher prevalence of emotional neglect than those depressive participants without pain. Data analysis has shown that severity of the depressive symptoms has a significant impact on the total score of childhood trauma, emotional abuse, physical abuse, emotional neglect, and physical neglect, and that emotional abuse, sexual abuse, and physical neglect have significant impact on the severity of depression. In conclusion, our findings indicate that ELS can be considered as a risk factor for the comorbidity between depression and chronic pain.
... Psychological maltreatment is not only a short-term crisis in a child's life but also may increase a child's vulnerability in adulthood. 18 A growing number of research has pointed out the relationship between childhood psychological maltreatment and psychological problems in adulthood, [19][20][21] and indicated that individuals who were exposed to abuse in childhood have more negative assessments about self. [22][23][24][25] In the oth-er words, childhood psychological maltreatment negatively affects development of self-concept, and may be the reason of depression. ...
... In this study, result of analysis as consistent with previous research indicated that childhood psychological maltreatment positively predicted depression [19][20][21][26][27][28] and negative self-concept. [22][23][24][25] Furthermore, the negative relationship between psychological maltreatment and resilience 6,11,15 was found. ...
Objective: The purpose of this study is to investigate the mediating role of resilience in the relationships between childhood psychological maltreatment, depression and negative self-concept in adulthood. Method: The sample included 320 adulthood living in Isparta, Turkey. Participants were 65.9% (n= 211) female, 34.1% (n= 109) male. The ages of the participants ranged between 20 and 39. The mean of ages was 24.62±3.93. Participants completed Brief Symptom Inventory, Childhood Trauma Questionnaire, and Adult Resilience Measure. Results: Results of analysis indicated that childhood psychological maltreatment directly predicted resilience, negative self-concept and depression in adulthood. Results also showed that childhood psychological maltreatment indirectly predicted negative self-concept and depression by mediated resilience. Conclusions: Results of the study showed that resilience has a partial mediating role in the relationship between psychological maltreatment-negative self-concept and psychological maltreatment-depression. Therefore, study results are very important on understanding the protective role of resilience in the relationship among these variables.
... Data have shown that nearly half of the participants were from middle age and this goes in line with a previous study done by [7] which stated that depressed older adults reported high rates of childhood abuse. Majority of them were males which was not expected because females are usually more sensitive, and this is not in line with the study by [8] which indicated that most of the patients were females and this contradiction was perhaps due to different locations of the study. Most participants that were diagnosed with depression and anxiety have grown with both parents which was way too far from our expectations which included parents divorcement as a main reason for depression and anxiety, and this goes in contrary with previous study by [9] that showed children in divorced groups had lower security scores on the Attachment Q-Set instrument. ...
Objectives: Abuse can occur at any stage of childhood leaving an impact on the individual's future mental health. It could be verbal, physical, and emotional. In this research, we focus on determining the correlation of childhood abuse and psychiatric patients with specific aims of identifying the link between depression and anxiety towards child maltreatment. Methods: This cross-sectional study was conducted in a psychiatric clinic among 155 depression and anxiety male and female patients who were randomly selected with age ranging from 20 to 50 plus years. The data were collected by a printed survey distributed manually. Results: Survey of 155 patients showed that (66.5%) raised with both parents. The punishment witnessed by patients in the household was physical (35.5%), emotional (26.5%), and verbal (18.1%). (51.6%) of the patients answered “yes'' when they were asked whether if their caregiver acted in a way scared patients' of getting hurt. Caregivers react to mistakes (X2 = 17.665; P = 0.007), caregiver acted in a way that made patients afraid of getting hurt (X2 = 8.396; P = 0.015). Other variables did not significantly influence anxiety and depression (All > 0.05). Conclusion: Overall, gender and growing with both parents may not affect the psychology of an individual, but maltreatment in childhood (e.g., resorting to physical punishments, constant threats from the caregiver) increases the chances of getting depression/anxiety in adulthood. Regarding our research, childhood maltreatment memories hunt adults in their future leading to psychological damage. Consequently, recognition of childhood maltreatment in family and PHC physicians' clinic might aid in treatment, selection, and management.
Aim
General Objective:
To determine the correlation of childhood abuse with psychiatric patients in Riyadh – Kingdom of Saudi Arabia (KSA).
Specific Objective
To identify the link between depression and anxiety to childhood maltreatment.To identify the correlation of childhood maltreatment with depression.To identify the correlation of childhood maltreatment with anxiety.
Settings and Design: A cross-sectional study consisted of 155 psychiatric patients randomly selected from the University Medical Centre, Riyadh, capital of Saudi Arabia, in January 2020. The samples contained psychiatric patients with depression and anxiety male and female ranging from 20 to 50 plus years. All participants voluntarily participated in this study. Methods and Material: Collection instrument is a self-administered, pre-coded, pre-tested questionnaire devolved mainly for the purpose of this study after consultation from literature and an epidemiologist containing data pertaining to diagnosis, socioeconomic states, and educational level. Statistical Analysis Used: Data were analysed using Statistical Packages for Social Sciences (SPSS) version 23 and Microsoft Excel to generate tables and charts with P < 0.05 considered significant. Data presentation tables are given below. All qualitative variables were presented in terms of numbers and percentages. The relationship between depression and anxiety among the basic demographic data and characteristics of patients during childhood maltreatment had been conducted using Chi-square test. A P < 0·05 was considered statistically significant. Data analyses were performed using SPSS version 21. Conclusion: The study concludes that the presence of maltreatment in childhood (e.g., resorting to physical punishments, constant threats from the caregiver) does in fact increase the chances of acquiring depression or anxiety in adulthood, while other factors (e.g., gender, presence of both parents) do not play a major role compared to maltreatment of the child. The psychological state of children must be well taken care of, and they should be brought up within a supportive healthy environment by a civilized parenting method. Based on our research, childhood maltreatment memories will hunt adults in their future and cause them serious psychological damage. That is why, the recognition of childhood maltreatment in family and primary health care (PHC) physicians' clinic might aid in treatment, selection, and management.
... It is well known that Adverse Childhood Experiences (ACEs -physical abuse, emotional and psychological abuse, and sexual abuse in childhood) are strongly correlated with depressive disorders. (Kauffman 1991, Goldberg 1994, Ferguson and Dacey 1997 It is also true that there is a dose-response relationship between the number of ACEs and a child's likelihood of developing a depressive disorder. (Chapman et al. 2004) This qualifies ACEs as a cause of depressive disorders on the interventionist model. ...
Major Depressive Disorder (MDD) is a serious condition with a large disease burden. It is often claimed that MDD is a “brain disease.” What would it mean for MDD to be a brain disease? I argue that the best interpretation of this claim is as offering a substantive empirical hypothesis about the causes of the syndrome of depression. This syndrome-causal conception of disease, combined with the idea that MDD is a disease of the brain, commits the brain disease conception of MDD to the claim that brain dysfunction causes the symptoms of MDD. I argue that this consequence of the brain disease conception of MDD is false. It incorrectly rules out genuine instances of content-sensitive causation between adverse conditions in the world and the characteristic symptoms of MDD. Empirical evidence shows that the major causes of depression are genuinely psychological causes of the symptoms of MDD. This rules out, in many cases, the “brute” causation required by the brain disease conception. The existence of cases of MDD with non-brute causes supports the reinstatement of the old nosological distinction between endogenous and exogenous depression.
... First and foremost, a significant body of literature indicates that the presence of psychopathology, including (for example) depression and PTSD, contributes to poorer functioning in youth. For example, Miller, et al., released a model indicated that the release of inflammatory cytokines following psychological stress contributes to the development of depression (Miller et al., 2009), which is associated with poorer functioning in pediatric pain populations in related research (Arnow et al., 2009;Goldberg, 1994). Additionally, Holley, et al., published a mutual maintenance model implicating the presence of PTSD in pain chronicity in youth . ...
Chronic pain in youth is common, with prevalence rates in some reports exceeding 50%. Given the plasticity of brain systems in youth and their general level of activity, the underlying processes relating to the evolution of chronic pain may be different from that observed in adults. One aspect that affects brain development is childhood stress. Preliminary research indicates that maladaptive responses to stressful events that induce biological and psychological inability to adapt may be related to pain chronicity in youth. This relationship is particularly notable given the high rates of exposure to stressful events in pediatric pain populations. A review of the literature was performed in the areas of biological, cognitive, psychological and social processes associated with chronic pain and psychological stress and trauma in youth and adult populations. The current review presents a theoretical framework, adapted from McEwen’s model (1998) on stress and allostatic load, which aims to outline the potential connection between exposure to stressful events and pediatric chronic pain. Avenues for future investigation are also identified.
... For example, economic inequality is related to ACEs and child maltreatment, 103,104 which are in turn related to various adverse health outcomes at the population level, 96,105,106 including addictions and persistent pain in adulthood. 95,[107][108][109][110] It seems clear that nonmedical determinants of persistent pain and addiction should be interrogated and addressed meaningfully by the physical therapy profession for it to realize the best possible credibility to participate in primordial prevention. In line with previous recommendations in the physical therapy literature [111][112][113] and the efforts of other health professional organizations, physical therapists can participate in social change and policy level actions that support opportunities for child development and family conditions that are unburdened by poverty, discrimination, and other adversities that lead to poor health outcomes. ...
The physical therapy profession has recently begun to address its role in preventing and managing opioid use disorder (OUD). This topic calls for discussion of the scope of physical therapy practice, and the profession's role, in the prevention and treatment of complex chronic illnesses, such as OUD. OUD is not just an individual-level problem. Abundant scientific literature indicates OUD is a problem that warrants interventions at the societal level. This upstream orientation is supported in the American Physical Therapy Association's vision statement compelling societal transformation and its mission of building communities. Applying a population health framework to these efforts may provide physical therapists with a useful viewpoint that can inform clinical practice and research, as well as develop new cross-disciplinary partnerships. This Perspective discusses the intersection of OUD and persistent pain using the disease prevention model. Primordial, primary, secondary, and tertiary preventive strategies are defined and discussed. This Perspective then explains the potential contributions of this model to current practices in physical therapy, as well as provide actionable suggestions for physical therapists to help develop and implement upstream interventions that may reduce the impact of OUD in their communities.
... Greater alcohol consumption in adolescence is observed in longer separations (360 min) from the dam compared to shorter separations (15 min) (Daoura et al., 2011;Huot et al., 2001). Besides anhedonia, chronic pain mediates a relationship between a history of child abuse and depression in humans (Goldberg, 1994). It should be no surprise that maternally separated animals, who have a high rate of depression, show a 78% progressive decrease in morphine aversion (Vazquez et al., 2005) and place preferences for morphine and increased intake (Vazquez et al., 2005). ...
Research on the inter-relationship between drug abuse and social stress has primarily focused on the role of stress exposure during adulthood and more recently, adolescence. Adolescence is a time of heightened reward sensitivity, but it is also a time when earlier life experiences are expressed. Exposure to stress early in postnatal life is associated with an accelerated age of onset for drug use. Lifelong addiction is significantly greater if drug use is initiated during early adolescence. Understanding how developmental changes following stress exposure interact with sensitive periods to unfold over the course of maturation is integral to reducing their later impact on substance use. Arousal levels, gender/sex, inflammation, and the timing of stress exposure play a role in the vulnerability of these circuits. The current review focuses on how early postnatal stress impacts brain development during a sensitive period to increase externalizing and internalizing behaviors in adolescence that include social interactions (aggression; sexual activity), working memory impairment, and depression. How stress effects the developmental trajectories of brain circuits that are associated with addiction are discussed for both clinical and preclinical studies.
... Moreover, compared to no risk, profiles of violence, maltreatment, psychopathology, and/or household "dysfunction," in general, seem to be associated with differential risk. These findings are consistent with previous research demonstrating the independent and cumulative effect of childhood adversity on psychopathology and engaging in sexual risk-taking and drinking behavior even decades later (Chapman et al., 2004;Ferguson & Dacey, 1997;Goldberg, 1994;Kaufman, 1991). The LCA analysis, though, allowed for a more nuanced look at specific ACE patterns that differentiated risk. ...
Studies of adverse childhood experiences (ACEs) have gauged severity using a cumulative risk (CR) index. Few studies have focused on the nature of the context of adversity and their association with psychosocial outcomes. The objective of this study was to examine the patterning of ACEs and to explore the resultant patterns' association with HIV risk-taking, problem drinking, and depressive symptoms in adulthood. Latent class analysis (LCA) was used to identify homogeneous, mutually exclusive "classes" of 11 of the most commonly used ACEs. The LCA resulted in four high-risk profiles and one low-risk profile, which were labeled: (1) highly abusive and dysfunctional (3.3%; n ¼ 1,983), (2) emotionally abusive alcoholic with parental conflict (6%, n ¼ 3,303), (3) sexual abuse only (4.3%, n ¼ 2,260), (4) emotionally abusive and alcoholic (30.3%, n ¼ 17,460), and (5) normative, low risk (56.3%, n ¼ 32,950). Compared to the low-risk class, each high-risk profile was differentially associated with adult psychosocial outcomes even when the conditional CR within that class was similar. The results further our understanding about the pattern of ACEs and the unique pathways to poor health. Implications for child welfare systems when dealing with individuals who have experienced multiple forms of early childhood maltreatment and/or household dysfunction are discussed.
... The field literature is replete with examples of clinical cases in which psychological disorders have gone handin-hand with concurrent and/or subsequent drug use, abuse, and dependence (Zvolensky, Buckner, Norton, & Smits, 2011). Over the past two decades, there has also been a preponderance of evidence that supports the view that childhood victimization can have a significant impact in adulthood in a variety of ways and in many areas of life (Edleson, 1999;Felitti et al., 1998;Goldberg, 1994;Herman, 1997). Nevertheless, there would appear to be little understanding of the impact of these coexistent issues on individual experience, and, despite the volume of literature that supports the existence of such complex problems, there are not many studies that focus on giving voice to the very people experiencing them. ...
Proceeding from a phenomenological perspective, the present study investigated the experiences of seven homeless women who had lived through childhood trauma and subsequent substance abuse, with specific focus on the recovery process experienced by each. Applying the analytical protocol of Giorgi (1985) to the written accounts obtained from the participants, 15 constituent themes of the recovery process were identified. In order to illuminate the participants’ experiences with minimal influence of any possible researcher bias, the researcher refrained from labelling, judging or diagnosing the women’s life circumstances. Consequently, no treatment paradigm was applied to help explain, predict or judge the behaviour of the participants during the course of this research.
... havainnoista, joiden mukaan aikaisempia negatiivisia elämäntapahtumia kokeneilla kroonisilla kipupotilailla sopeutuminen on usein huonompaa (Linton ym., 1996;Naidoo & Pillay, 1994;Sherman ym., 2000;Spertus ym., 1999). Lisäksi depressio on yleisempää niillä kroonisilla kipupotilailla, jotka ovat joutuneet lapsuudessa seksuaalisen hyväksikäytön uhreiksi (Goldberg, 1994;Walker ym., 1992;ks. myös Spertus ym., 1999). ...
... Moreover, there is commonly a dose-response relationship between the number of types of adversity associated and the magnitude of the risk for depression. [4][5][6][7][8][9][10][11] Statistical modeling demonstrates mediation by multiple intermediate variables, potentially acting with different degrees of effects at varying life stages. These include personality (neuroticism), low self-esteem, conduct disorder, increased risk of adverse life events, low social support, and difficulties in interpersonal relationships. ...
We review studies with human and nonhuman species that examine the hypothesis that epigenetic mechanisms, particularly those affecting the expression of genes implicated in stress responses, mediate the association between early childhood adversity and later risk of depression. The resulting studies provide evidence consistent with the idea that social adversity, particularly that involving parent-offspring interactions, alters the epigenetic state and expression of a wide range of genes, the products of which regulate hypothalamic-pituitary-adrenal function. We also address the challenges for future studies, including that of the translation of epigenetic studies towards improvements in treatments.
... 1. Early childhood Trauma can predispose a person to pain later in life; Patients with pelvic pain have been found to have rates of childhood sexual abuse and physical abuse from 14 to 64%. (Walker et al, 1998;Fry et al 1993, Toomey et al, 1993 In patients with pain in other areas of their body, rates of childhood abuse were found to range from 28 -48% (Wurtele et al;1990, Goldberg, 1994Toomey et al, 1995). ...
... Also victims of adult sexual assault also show more psychological difficulties than non-victims (389). Psychiatric morbidity in association with sexual or physical abuse include depression (115), posttraumatic stress disorder (294), substance use disorders (302), dissociative symptomatology (42) shown that being abused as a child is the most independent and largest factor associated with depression, thus an adolescent or adult with abuse history is three or four times more likely to become depressed (40). ...
... Early adversity has been linked to increased risk for depressive symptoms (Chapman et al., 2004), MDE onset , and MDE maintenance (Brown & Moran, 1994;Riso, Miyatake, & Thase, 2002;McLaughlin et al., 2010). Whereas some studies have reported evidence consistent with an additive risk model (i.e., a dose-response relation between number of adversities and depression severity) for depressive symptoms (Goldberg, 1994;Surtees et al., 2006) and diagnoses (Kendler et al., 2000), other studies have shown that associations between childhood adversity and depression were non-additive and stronger for particular types of adversity (Kessler, Davis, & Kendler, 1997). ...
Objectives:
This prospective study investigated whether within-individual relations between depression vulnerability factors (childhood trauma, dysfunctional attitudes, maladaptive coping) and depressive symptom trajectories varied as a function of the number of prior major depressive episodes (MDEs) experienced in their lifetime.
Design:
Participants were 68 young adults who varied with regard to their history of depression; 32 were remitted depressed and 36 were never depressed.
Methods:
Depressive symptoms and disorders were assessed using semi-structured psychiatric interviews conducted twice over a 6-month period; interviews yielded weekly ratings of depressive symptoms during the follow-up interval. Childhood trauma, dysfunctional attitudes and coping were assessed with self-report measures. Data analyses were conducted using time-lagged multilevel models.
Results:
Individuals with more previous MDEs who reported greater childhood trauma exposure, more dysfunctional attitudes, or greater use of maladaptive coping strategies experienced more rapid increases in depressive symptoms during the follow-up period. A significant interaction of coping, number of previous MDEs, and time was found indicating that among individuals with less adaptive coping (i.e., lower primary or lower secondary control coping scores), depressive symptoms rating (DSR) increased significantly in relation to number of prior depressive episodes; no change in DSR was observed for never-depressed individuals. Among individuals with higher primary control coping scores, significant increases in DSR scores were observed for individuals with ≥3 prior MDEs only.
Conclusions:
Findings highlight the need for treatment and prevention programmes that target stress reactivity and coping strategies early in the course of depression.
... Such associations were significant for both men and women; remained significant when adjusting for living with a mentally ill parent (thus removing the effects of a gene-environment correlation – it may be the sharing of depressogenic genes with a parent that leads to depression, not the environmental adversity); and showed a dose-response relationship, with a greater number of types of adversity associated with a greater risk for depression. Many studies have found a similar strong association (with a clear dose-response relationship where measured) between childhood adversity and adult depressive symptoms (Goldberg, 1994; Surtees et al., 2006) and adult depressive disorder (Caspi et al., 2003; Kendler et al., 2000; Parker, 1979). Recent findings from the National Comorbidity Survey Replication have shown 10 that multiple types of childhood adversity are associated with first-episode onset and persistence of a wide range of psychiatric disorders (including depression) (Green et al., 2010; McLaughlin et al., 2010). ...
Childhood adversity is associated with increased risk for onset of depressive episodes. This review will present evidence that allostatic overload of the hypothalamic-pituitary-adrenal axis (HPAA) partially mediates this association. The HPAA is the physiological system that regulates levels of the stress hormone cortisol. First, data from animals and humans has shown that early environmental adversity is associated with long-term dysregulation of the HPAA. This may occur due to permanent epigenetic modification of the glucocorticoid receptor. Second, data from humans has demonstrated that HPAA dysregulation is associated with increased risk of future depression onset in healthy individuals, and pharmacological correction of HPAA dysregulation reduces depressive symptoms. HPAA dysregulation may result in corticoid-mediated abnormalities in neurogenesis in early life and/or neurotoxicity on neural systems that subserve emotion and cognition.
... Abuse has been found to be associated with several internalizing disorders. Depression is common among adult survivors of childhood physical and sexual abuse (Goldberg, 1994;Levitan et al., 1998;Molnar et al., 2001;Roosa, Reinholtz, & Angelini, 1999;Sachs-Ericsson et al., 2006;Turner & Muller, 2004;Zuravin & Fontanella, 1999). Studies using longitudinal designs and based on identified abused samples have shown this association. ...
First, to determine if childhood experiences of abuse have an impact on internalizing disorders (e.g., anxiety and depressive disorders) among older adults. Second, we wish to determine if self-esteem plays a role in explaining the relationship between abuse and internalizing disorders.
First, we conducted an analysis on a population sample of participants aged 50 years or older (mean age = 67 years; SD = 10.3) assessed at two time points, three years apart (Wave 1, N = 1460; Wave 2, N = 1090). We examined the relationship between reports of childhood abuse (physical, emotional, and sexual) and internalizing disorders. Second, we determined the role self-esteem played in explaining the relationship.
We found that childhood experiences of abuse assessed at Wave 1 predicted the number of DSM-IV internalizing disorders occurring three years later. Demonstrating the specificity of self-esteem; we found self-esteem, but not emotional reliance, to moderate the relationship between abuse and internalizing disorders such that childhood abuse had more negative effects on those with low self-esteem compared to those with higher self-esteem. Contrary to prediction, self-esteem did not mediate the relationship between abuse and internalizing disorders.
The negative effects of childhood abuse persist for many years, even into older adulthood. However, contrary to the findings in younger adults, self-esteem was not correlated with childhood abuse in older adults. Moreover, childhood abuse only had a negative effect on those who had low self-esteem. It may be through the process of lifespan development that some abused individuals come to separate out the effects of abuse from their self-concept.
... Numerous studies have found significantly higher levels of depression in sexually traumatized women (Briere & Runtz, 1989;Carlin & Ward, 1992;Goldberg, 1994;Miller et al, 1995). Furthermore, a meta-analytic review of 22 studies comparing sexually victimized college women to controls found a significant effect size for depressive symptomatology (Rind, Tromovitch, & Bauserman, 1998). ...
Recent investigations have suggested that sexual victimization is related to longterm physical health. This study examined three pathways (i.e., depression, posttraumatic stress, and health behaviors) by which this relationship may exist. Participants were 107 sexually victimized college women. Results indicated that depression partially mediated between sexual victimization and each of the following outcomes: health perceptions, physical symptoms, functional disability, and pain severity. Similarly, posttraumatic stress partially mediated between sexual victimization and both health perceptions and physical symptoms. Regarding health behaviors, results indicated that sexual-risk-taking partially mediated between posttraumatic stress and number of pain sites. General health behaviors mediated between posttraumatic stress and both health perceptions and medical utilization. These results suggest that even among young, relatively healthy women, sexual victimization is related to several negative health outcomes. Depression and posttraumatic stress partially accounted for this relationship in many instances. However, health behaviors were not consistently found to mediate the relationship. Thesis (M.S.)--University of Georgia, 2004. Directed by Joan L. Jackson. Includes bibliographical references (leaves 88-108). Electronic reproduction. s
... Some of this increased pain may be due to depression. Depression is common among adult survivors of abuse (Goldberg, 1994;Levitan et al., 1998;Molnar et al., 2001;Roosa, Reinholtz, & Angelini, 1999;Turner & Muller, 2004;Zuravin & Fontanella, 1999) and among patients with chronic pain (Faucett, 1994;Fishbain, Cutler, Rosomoff, & Rosomoff, 1997;Magni, Moreschi, Rigatti-Luchini, & Merskey, 1994;McWilliams, Cox, & Enns, 2003). Moreover, past research has shown that depression increases pain reports among individuals with health problems (Hernandez & Sachs-Ericsson, 2006). ...
The current article reviews recent research demonstrating the relationship between childhood physical and sexual abuse and adult health problems. Adult survivors of childhood abuse have more health problems and more painful symptoms. We have found that psychiatric disorders account for some, but not all, of these symptoms, and that current life stress doubles the effect of childhood abuse on health problems. Possible etiologic factors in survivors' health problems include abuse-related alterations in brain functioning that can increase vulnerability to stress and decrease immune function. Adult survivors are also more likely to participate in risky behaviors that undermine health or to have cognitions and beliefs that amplify health problems. Psychiatric disorders, although not the primary cause of difficulties, do have a role in exacerbating health and pain-related problems. We conclude by outlining treatment recommendations for abuse survivors in health care settings.
childhood abuse and suicide risks
OBJECTIVE
The present article reviews the methods and criteria used to assess risk behavior in adolescents.
METHODS
Non-systematic review of scientific literature, as well as the assessment of the clinical and research experience accumulated by the Adolescent Outpatient Clinic of the Hospital de Clínicas de Porto Alegre.
RESULTS
Physicians can apply a comprehensive healthcare model by using a psychosocial approach, trying to understand the influence the media exerts on adolescents, and trying to establish a confidentiality relationship with them. The major factors that should be evaluated regarding risk behavior among adolescents include clinical and nutritional aspects, as well as sexuality, violence, mental health and alcohol and drug use issues.
CONCLUSIONS
Health care providers should use their sensitivity and expertise, in addition to establishing ethically clear approaches to evaluate risk factors. The authors suggest a route of investigation of risk behavior that should be used in routine consultation.
OBJECTIVE:
In the absence of a proven medical explanation for the chronic pain syndrome Complex Regional Pain Syndrome type I (CRPS I), this study explored a hypothetical link between childhood physical and sexual abuse, and the subsequent development of CRPS I. The hypothesis predicts the existence of a subpopulation of CRPS I patients with a high frequency of dissociative experiences corresponding to a history of childhood trauma.
DESIGN:
To test this theory, CRPS I patients attending the Auckland Hospital Pain Clinic, Auckland, New Zealand were assessed by self-report questionnaires for their frequency of dissociative experiences and for a history of childhood abuse. The data were compared with those of a low back pain control group and a healthy, pain-free control group.
RESULTS:
CRPS I patients were not unusually dissociative and had not experienced significantly higher rates of childhood abuse than the general population. Two of the 18 CRPS I patients were highly dissociative; both reported childhood sexual abuse.
CONCLUSIONS:
A trauma-dissociation pathway to CPRS I was not found. The desirability of screening for that subpopulation of CPRS I sufferers who may have been abused is discussed.
The pediatric psychiatrist offers special skills in the evaluation of children with pain. Psychiatrists should follow the same process of evaluating a patient with pain as do other medical specialists. The goal is integration of care for the whole child. Pain complaints should be taken seriously and be regarded as genuine, with the rare exception of children found to have malingering or factitious disorders. Often patients have organically based disorders that may not be appreciated at the time of consultation. Interdisciplinary collaboration helps ensure that both the physical disorder and complicating psychologic factors are appropriately evaluated. Psychiatrists should take an active role in the care of patients with pain to ensure optimal pharmacologic management. In addition, psychiatrists offer unique expertise in evaluating the multiple psychosocial components that influence a child's perception of and response to pain. A psychiatric disorder should never be a diagnosis by exclusion. Psychiatric assessment allows the identification of psychiatric conditions that interact to increase pain perception and morbidity. Pain can also trigger or exacerbate psychiatric conditions. Accurate diagnosis is important in communication among clinicians and researchers and in treatment planning. Psychiatric disorders should be identified and treated aggressively and not viewed as an expected reaction to pain or illness. In addition, through an appreciation of the influence of culture, family, stressors, and other factors that contribute to a child s pain or behavior, the psychiatrist can help coordinate multidisciplinary efforts to provide truly comprehensive care to the child with pain.
Im folgenden Kapitel werden die Ansätze zur Konzeptionalisierung von „Schmerzpersönlichkeiten“ beleuchtet. Die einflussreiche Theorie der „pain prone personality“ von Engel wird vorgestellt. Anschließend werden die empirisch-methodischen Voraussetzungen zur Identifizierung spezifischer Persönlichkeitsmuster und zur Verifizierung der Hypothese ihrer Prämorbidität dargestellt sowie der empirische Evidenzstatus untersucht. Typische, verstärkt auftretende Merkmale von Schmerzpatienten (z. B. Neurotizimus) werden als Charakteristika einer allgemeinen „chronic disease personality“ identifiziert. Im Rahmen der Interaktionstheorie von Mischel werden verschiedene Verhaltens- und Erlebensdispositionen (z. B. Katastrophisierung, Bewältigungsverhalten) auf ihre Bedeutung für die Schmerzentwicklung und die Behandlung chronischer Schmerzen hin untersucht.
When The Body Bears the Burden made its debut in 2001, it changed the way people thought about trauma, PTSD, and the treatment of chronic stress disorders. Now in its third edition, this revered text offers a fully updated and revised analysis of the relationship between mind, body, and the processing of trauma. Here, clinicians will find detailed, thorough explorations of some of neurobiology’s fundamental tenets, the connections between mind, brain, and body, and the many and varied ways that symptoms of traumatic stress become visible to those who know to look for them.
Objective
Three possibilities may explain headache and depression comorbidity: (a) headaches cause depression; (b) depression causes headaches; and (c) third variables cause both. Evidence supports all three possibilities. This study sought to examine which of these has the most support among a sample of people seeking psychological treatment.Method
This was achieved firstly by establishing the order of onset of the most recent episode of headaches and depression, comparing these groups on headache severity, depression heritability, and exploratory variables, and asking participants open-ended questions. Thirty participants had been diagnosed with a primary headache disorder and major depressive disorder. The order of onset was assessed using the Life History Calendar, while depression heritability was estimated by probable depression in a parent.ResultsAlthough the order of onset was statistically random, it was more frequent for participants to state that depression caused headaches than the reverse. Most participants identified life events or circumstances as contributing to both conditions. Unusually intense headaches may be contributing to depression in the headaches first group, although headaches causing depression may be infrequent.Conclusions
Successful headache treatment for individuals with major depressive disorder will most likely necessitate treatment of the comorbid depression. This study was limited by a small sample size.
Objectives:
Childhood sexual abuse has previously been associated with adult mental health difficulties, however, few studies have evaluated all forms of childhood maltreatment in individuals attending adult mental health services. Consequently, this study investigates the association of five forms of childhood trauma with a range of clinical symptoms and mental health disorders in 136 individuals attending a mental health service in Ireland utilising the Childhood Trauma Questionnaire (CTQ).
Method:
One hundred and thirty-six patients attending the Roscommon Mental Health Services completed the CTQ and a number of additional psychometric instruments evaluating illness severity, impulsivity, disability and the presence of a personality disorder(s) (PD) to ascertain the prevalence of childhood trauma and any potential associations between childhood trauma and a range of demographic and clinical factors. Result Seventy-six per cent of individuals reported childhood trauma, with emotional neglect most frequently reported (61%). Individuals who had experienced childhood trauma had higher rates of clinical symptoms, distress and impulsivity. Substance abuse and paranoid, borderline and antisocial PDs most associated with childhood trauma.
Conclusion:
This study demonstrates the need to routinely elicit information on all forms of childhood traumatic experiences from patients.
PURPOSE: To assess the prevalence of Temporomandibular Disorders (TMD) and Orofacial Pain (OFP) in women victim of domestic violence, and the impact of chronic pain in related psychosocial factors, such as depression and somatization, as well as in the women's quality of life. METHODS: A convenience sample of 20 women in a situation of domestic violence who accessed support institutions were voluntarily interviewed. OFP and related psychosocial factors were assessed by using the RDC/TMD (Research Diagnostic Criteria for TMD) Axis II, and the history of physical and sexual abuse by the S/PAHQ (Sexual and Physical Abuse History Questionnaire). RESULTS: Eighty percent of women victim of violence showed chronic pain, varying from 1 to 3 on a four-point scale (0 to 3), 65% showed severe depression, and 60-70% reported evere somatization with or without pain, respectively. In addition, 85% reported pain in the face, temples and ear in the last month with a recurrent pattern. CONCLUSION: Data indicated high prevalence of TMD and OFP in this sample. There is a need for qualification of health professionals dealing with abused women in order to identify the presence of TMD and OFP as well as depression and somatization.
Research on the association between adverse childhood events (ACEs) and depression among women in Hawaii is scarce. ACEs have been linked to unfavorable health behaviors such as smoking and binge drinking which are more prevalent in the state compared to the US overall. The concomitant presence of ACEs with smoking or binge drinking may explain the excess depression prevalence in Hawaii compared to the national average. Using data of women residing in the state (2010 Hawaii Behavioral Risk Factor Surveillance System Survey), we examined the association between ACEs count or type (household dysfunction and physical, verbal and sexual abuse) and current depressive symptoms (CDS), in addition to modification by current smoking status (smoked >100 cigarettes in a lifetime and currently smoke) and binge drinking (consumed ≥4 alcoholic beverage within the past month and in ≥1 occasion(s)). Evaluation of ACEs before age 18 consisted of 11 indicators. Eight indicators of the Patient Health Questionnaire (PHQ-8) were used to assess CDS. All analyses utilized logistic regression taking into account sampling design. The odds ratio of having CDS between those with versus without ACEs increased per increasing number of ACEs (1 ACE: OR = 2.11, CI = 1.16-3.81; 2 ACEs: OR = 2.90, CI = 1.51-5.58; 3 or 4 ACEs: OR = 3.94, CI = 2.13-7.32; 5+ ACEs: OR = 4.04, CI = 2.26-7.22). Household dysfunction (OR = 2.10, CI = 1.37-3.23), physical abuse (OR = 1.67, CI = 1.08-2.59), verbal abuse (OR = 3.21, CI = 2.03-5.09) and sexual abuse (OR = 1.68, CI = 1.04-2.71) were all positively associated with CDS. Verbal abuse had the strongest magnitude of association. Neither current smoking status nor binge drinking modified the relationship between ACEs count (or type) and CDS. In conclusion, the presence of ACEs among women in Hawaii was indicative of CDS in adulthood, notably verbal abuse. Further, a dose response existed between the number of ACEs and the odds for CDS. The concomitant exposure to ACEs and current smoking status or binge drinking did not elevate odds for CDS.
Steeds meer wordt duidelijk dat psychosociale stress een belangrijke rol kan spelen in het chronisch worden en voortduren
van pijn en hiermee verbonden functionele beperkingen (Melzack, 1999; Van Houdenhove, in druk). Tegen deze achtergrond wordt
in dit artikel de potentiële etiologische rol van emotioneel, fysiek, en seksueel misbruik nagegaan. Eerst worden de onderzoeken
over de prevalentie van misbruik bij verschillende typen chronische pijn besproken, en worden enkele methodologische problemen
aan de orde gesteld. Vervolgens wordt een overzicht gegeven van de mogelijke verklaringen voor de relatie tussen misbruik
en chronische pijn. Ten slotte worden conclusies getrokken voor de klinische praktijk.
To further explore the controversy as to whether childhood molestation is associated with chronic pain in adulthood.
Community nonpatients without pain (CNPWP), community patients with pain (CPWP), acute pain patients (APPs), and chronic pain patients (CPPs) were compared for endorsement of affirmation of childhood molestation by chi-square. Logistic regression was utilized to predict affirmation in male and female CPPs.
A significantly higher percentage of male APPs affirmed molestation versus CNPWP and CPWP. No other comparisons were statistically significant for males. For females, no comparisons were significant. For male CPPs, the behavior health inventory-2 (BHI-2) survivor of violence scale and 1 item from this scale predicted affirmation. The following BHI-2 scales and items predicted affirmation for female CPPs: muscular bracing and survivor of violence scales; the item "I have been a victim of many sexual attacks"; and the item "My father was kind and loving to me when I was growing up" (scored opposite direction).
In female PWCP, the prevalence of childhood molestation is not greater than in a number of unique comparison groups. Unique predictors of childhood molestation are yet to be identified.
There is a significant group of chronic pain patients with complex psychosocial needs who are frequent users of hospital outpatient departments and who do not participate in or benefit from traditional pain management treatments and are convinced there is a medical solution to their problems. They are a particularly challenging group of patients to help, often shunned by medical and psychological professionals. A new type of ten-session psycho-social group for these patients that is less demanding than traditional pain management group programmes is investigated. It is designed to foster the development into community-based self-help groups and reduce the need for professional support and unnecessary medical intervention. Accounts of four groups of patients who participated in support groups and successfully established their own groups is presented. To assess changes in motivation, mood and pain disability standardized questionnaire measures were given before and after group attendance. Findings suggest that patients benefited and took increased responsibility for their pain management but did not demonstrate positive changes on measures of mood or level of pain disability. Patients experienced satisfaction with the groups and established their own self-help community groups. The positive experience of participants and staff suggests further work with support groups would be productive for this group of patients.
Objectives: Previous studies have suggested that there are psychological, physiological, and biochemical factors contributing to chronic low back pain [CLBP]. No previous study has related these factors, though biopsychosocial models of pain are widely hypothesized. The current study aimed to determine psychological, electromyographic, and biochemical components involved in CLBP patients and compare these with a matched healthy normal control [HNC] group. Methods: Twenty-three chronic low back pain patients and 23 matched non-pain controls completed a psychological questionnaire derived from the Minnesota Multiphasic Personality Inventory. Static and dynamic electromyographic analysis of the lumbar paraspinals was performed. Additionally saliva samples were taken from a matched group of pain and thirty-eight HNC subjects and analyzed for the neuropeptides substance P [SP] and neurokinin A [NKA]. Results: Chronic low back pain patients were found to show a significantly higher frequency of depression, hypochondriasis, hysteria, and psychasthenia [P < 0.001]. Significantly increased paraspinal activity and asymmetry as compared with the matched HNC group was found [P < 0.05]. A significantly increased level of SP [P < 0.05] as compared with the HNC group was also found, though no significant difference was found for NKA. A correlation matrix found there to be a significant correlation between the psychological variables for both groups [P < 0.01], the electromyography results for both groups [P < 0.05], and between SP and NKA [P < 0.05] for both groups. However, no correlation between variables from the separate categories were found. Conclusions: Although there were several limitations to this cross-sectional study, these measures are interpreted as supporting a possible model of CLBP which incorporates psychological, biomechanical, and biochemical components. However, the relationship between these components is undetermined. Further, individuals may be affected differently by the particular components.
Chronic pain involves a somatic basis that is distinct from that of acute pain. It differs in its subjective experience and involves behavioral, personality, and syndromal pathologies which serve to worsen function and quality of life. Prior psychopathology makes an important contribution. The final state is one of both somatic and psychic suffering such that the two are not phenomenologically or etiologically distinguishable. Assessment and treatment must deal with the psychopathology as well as the physical pathology.
Fifty to 72% of long-term care (LTC) residents suffer from chronic or intermittent pain that limits activities of daily living
(ADL) (Bressler, Keyes, Rochon, & Badley, 1999; Cipher & Clifford, 2004). The efficacy of nonpharmacological treatment for
chronic pain management (psychotherapy, biofeedback, relaxation training, hypnosis, physical therapy, exercise, and behavioral
interventions) is well established in the clinical psychology literature for both older and younger adults (Cipher, Fernandez,
& Clifford, 2001, 2002; Simmons, Ferrell, Schnelle, 2002). Specifically, cognitive-behavioral therapy (CBT) has been an effective
modality within an interdisciplinary care team approach focusing on improving the quality of life (QOL) in chronic pain patients
(Morley, Eccleston, & Williams, 1999). Sorkin (1990) suggests that older and younger patients with chronic pain are more alike
than different in their response to CBT, particularly if the patients are cognitively intact and only suffering from mild
levels of physical disability. But when a LTC resident suffers from both cognitive and physical impairments, the assessment
and treatment process must be modified considerably (Cipher & Clifford; Cipher, Clifford, & Roper, 2007; Snow et al., 2004).
This chapter focuses on CBT for LTC residents with pain and comorbid physical or cognitive impairments, aiming to help clinicians
meet the challenges of modifying CBT for this special population. While this chapter highlights the kinds of modifications
required to accommodate the physical and cognitive impairments common in LTC settings, the approaches presented herein are
to a large extent also applicable to community-dwelling older adults across the spectrum of ability and disability.
The present confusion concerning cause, terminology, diagnosis, and treatment in the field of chronic orofacial pain is discussed.The
four complexes of facial arthromyalgia, atypical facial pain, atypical odontalgia, and oral dysesthesia are described both
in terms of physical symptoms and signs and in terms of associated personality and psychiatric problems. Recent studies are
critically reviewed. The roles of antidepressant agents and cognitive behavioral therapy in the management of chronic orofacial
pain are established.The need for multidisciplinary clinics and specific training programs is reiterated and the value of
the liaison psychiatrist emphasized.
Chronic temporomandibular joint dysfunction is a common pathological condition affecting the joint(s) and the associated muscles of mastication. It may be clinically expressed as unilateral or bilateral pain of the related area, diminished mouth opening, various sounds of the joints and occasionally ear symptoms. The etiology constitutes the radix of the treatment. Therefore, education and assessment of a broad spectrum of predisposing and promoting factors would lead to a more specific treatment plan. The management of the chronic temporomandibular joint dysfunction could be simple or complex. The choice of the treatment, based on the etiology, may be characterized as psychological or operational. The conservative treatment is beneficial in most of the cases. This literature review focused on the pathogenesis and the management of this complex clinical entity.
Though there are myriad etiologies of CPP, common therapeutic targets include inflammation, somatic dysfunction, and psychological disturbances. Inflammation may be addressed not only with dietary changes including nutritional and botanical supplements but also with mind-body therapies. Somatic dysfunction may respond to manipulative therapies provided by osteopaths, naturopaths, chiropractors, and some physical therapists. Therapists may also offer visceral, craniosacral, myofascial, and other whole-body therapies, as can highly trained massage therapists and bodyworkers. Mental health care may be key in many cases. Integrative medicine heralds the return to a sense of the human being's intrinsic capacity for healing, incorporating the vitalism of many of the therapies' origins (traditional Chinese medicine, indigenous medicine, ayurveda, osteopathy, chiropractic, etc) with the gains made by a more reductionistic tradition. Given the complexity and wide variation of etiologies and symptoms of CPP, using an integrative approach may offer expanded therapeutic solutions. We must expand our capacity to listen to each patient-with ears, eyes, mind, heart, and hands. Each treatment plan may then be tailored to the unique history and perspective that lie within the individual. Doing so requires the essential elements of time, skill, and love.
Mit Hinblick auf schmerzerklärende Mechanismen eines neuronalen Schmerz-gedächtnisses wurden Zusammenhänge zwischen realen und beobachteten Schmerz-/ Gewalterfahrungen (sexueller, physischer Missbrauch, Schmerzerfahrungen durch Krankheiten/ Unfälle/ Behandlungen, vor/ nach dem 16. Lj.) und somatoformen Schmerzen und Psychopathologien untersucht. Einflüsse von Schmerz-/ Gewalterfahrung auf Analgetikaeinnahme und Arztbesuche sowie eine mögliche Protektion psychotherapeutischer Behandlungen auf somatoforme Schmerzen und Psychopathologie, wurden sekundär untersucht. Dazu wurden 338 Studienpatienten (245 Frauen, 93 Männer), die aus der Psychosomatischen Ambulanz der Uniklinik Freiburg und aus verschiedenen Arztpraxen rekrutiert worden sind, eingeschlossen. Verglichen wurden drei Schmerzgruppen, wobei 150 Patienten eine Gruppe "somatoformer Schmerz", 65 Patienten eine Gruppe "chronischer Schmerz, assoziiert mit organischem Befund" und 123 Patienten eine Gruppe "kein chronischer Schmerz/ schmerzfrei" bildeten. Erhobene Daten aus den selbstauszufüllenden Fragebögen "FKG" (Abfrage von Schmerz-/ Gewalterfahrungen und chronische Schmerzen) und "SCL90 - R", wurden mit Hilfe von X², Nicht-parametrischen Tests und Regressionsrechnungen analysiert.
Patienten mit realen Schmerz-/ Gewalterfahrungen haben ein signifikant höheres Risiko (OR>3), somatoforme Schmerzen und andere chronische Schmerzen zu entwickeln, verglichen mit Patienten ohne Gewalterfahrungen; besonders starken Einfluss zeigen reale Schmerzerfahrungen durch Krankheit/ Unfall und reale physische Gewalt. Reale Schmerz-/ Gewalterfahrungen führen bei Patienten zu signifikant auffälligen Psychopathologien, am stärksten sind hierbei somatoforme Schmerzpatienten betroffen. Patienten mit realen Schmerz-/ Gewalterfahrungen zeigen erhöhte Arztfrequenzen (p<0.05) und vermehrter Analgetikaeinnahmen.
It has been theorized that low back pain contributes to the development of negative cognition (negative thinking) which may predispose a person towards chronicity. The objective of this paper is to examine the role of negative cognition in non-depressed participants who have previously experienced low back pain.
Ten students enrolled in a course at the University of Kansas were involved in a 4 week educational project. The participants completed self-rated assessments of depression using the 21 item Beck Depression Inventory (BDI-21) and the visual analogue pain scale (VAS). The study was broken into 3 phases over 4 weeks. Phase 1 focused on the VAS and the BDI-21 along with questions pertaining to low back pain. Phase 2 included 2 questions with 1 of the questions focusing on common negative distortions. Phase 3 focused on 11 clinical-type questions relating to awareness of negative thinking and chronic low back pain.
Phase 1 showed that 7 of the students had a history of chronic low back pain while 8 students believed they had negative thoughts when low back pain occurred. Conversely, only 1 student had experienced negative thoughts prior to a low back pain episode. The initial BDI-21 scores demonstrated a mean score of 5.5 with a mean VAS of 5.75. After students were exposed to the idea that they may have negative cognition processes (phase 2), 4 students indicated that they noticed themselves thinking negatively and attempted to alter such processes. Phase 3 results indicated that 4 of the students did attempt to change negative thinking after being made aware that negative thinking could be present.
The results of this study showed that a majority of participants believed that a person's negative thoughts can impair a person toward activity yet none of the participants believed that such had occurred to them. Further research in the area of negative cognition and chronic low back pain is needed.
Chronic pain complaints often reflect or are influenced by psychiatric factors. Physicians commonly encounter "illness-affirming behaviors" in which patient complaints or symptoms go beyond what should be expected from a specific disease process. In this paper, I describe common psychiatric conditions that often feature pain as part of the illness: somatization disorder, hypochondriasis, factitious physical disorders, pain associated with psychological factors (new DSM-IV nomenclature), and malingering. These conditions can be distinguished based on the conscious awareness (or lack of awareness) of both motivation and symptom production. Other psychiatric disorders may strongly influence chronic pain without directly causing it--depression, anxiety, panic, and post-traumatic stress disorders. Except for malingering and factitious pain, chronic pain should be regarded as genuine. Effective management requires psychiatric as well as biological considerations.
Low back pain (LBP) is a common problem that is costly in both financial and human terms. The impact of LBP on an individual varies greatly. For some, LBP is a minor inconvenience; but for others LBP is associated with significant disability and with psychosocial dysfunction for the individual and for the family. Whether psychosocial factors are causes or consequences has been the subject of debate. This paper is a review of psychosocial factors associated with disabling LBP. It addresses the question of whether these factors are causes or consequences of the disability due to LBP. Based on this review it was concluded that there is little evidence in support of the concept of a pain-prone personality. Once LBP has occurred, the impact of the LBP on the individual and the family is influenced by the health-beliefs and coping strategies of the individual and the family. Distress appears to be secondary to physical restriction rather than pain, but the distress may aggravate the pain and thus the disability. The paper concludes with a discussion of the impact of health practitioners on pain-related disability.
Patients with chronic non-malignant pain are often suspected of reporting medical symptoms that have non-organic as opposed to purely organic origins. According to the somatization hypothesis, non-organic reporting occurs when affective or other benign physical sensations are misconstrued as symptoms of physical disease [corrected]. Psychological tests purporting to assess somatization are limited by their self-report format and may be confounded in patients with physical disease or injury. Measures of somatization may also be influenced or biased by underlying differences in depression or anxiety. In order to obtain an unbiased estimate of somatization, therefore, it is necessary to control for the influence of extraneous variables. In the present study, symptom report scales designed to assess somatization, symptom amplification, and disease conviction were administered to a group of 100 patients with chronic non-malignant pain. The strategy was to determine whether any of these tests could account for individual differences in illness behavior. Specifically, the set of dependent measures included: length of disability; frequency of medical visitation; activity level; and level of domestic functioning. The most successful predictor of patient behavior was the Somatization Scale (Derogatis et al. 1974) which correlated positively and significantly with each dependent measure. In order to examine the possibility that scores on this test were biased by differences in organic pathology, three physician pain specialists were asked to rate the morbidity of each item on the scale. A multiple regression analysis was then performed to examine whether differences in symptom morbidity, depression, or anxiety could account for the correlation between symptom ratings and illness behavior. The analysis showed that while depression and anxiety were significantly correlated with measures of illness behavior, the Somatization Scale still accounted for a significant amount of unique variance in three out of five dependent variables. Symptom morbidity was significantly correlated with only one measure of illness behavior (Activity Level). In view of these findings, scores on the Somatization Scale were used to classify 25 patients as Symptom Minimizers and another 25 as Symptom Amplifiers. When compared to Minimizers, Amplifiers were disabled for a significantly greater number of days, reported significantly more impairment in domestic functioning, were significantly less active, visited the doctor significantly more often, and were significantly more distressed. The results suggest that substantial differences in disability and medical visitation may exist among patients who may not differ appreciably in their level of organic pathology. Instead, differences in illness behavior may, to some extent, be mediated by differences in somatization.
A study was conducted to investigate chronic pain patterns in Vietnam veterans with posttraumatic stress disorder (PTSD). Combat veterans with PTSD completed standardized PTSD severity, pain, somatization, and depression measures. Of 129 consecutive out-patient combat veterans with PTSD, 80% reported chronic pain. In descending order were limb pain (83%), back pain (77%), torso pain (50%), and headache pain (32%). Compared to PTSD combat veterans without chronic pain, PTSD veterans who reported chronic pain reported significantly higher somatization as measured by the Minnesota Multiphasic Inventory 2 hypochondriasis and hysteria subscales. In the sample of 103 combat veterans with PTSD and chronic pain, MMPI 2 hypochondriasis scores and B PTSD symptoms (reexperiencing symptoms) were significantly related to pain disability, overall pain index, and current pain level MMPI 2 hypochondriasis and depression scores were also significantly related to percent body pain. These results are discussed in the context of current conceptualizations of PTSD.
The purpose was to examine the relationships between traumatic events in childhood, such as sexual and physical abuse, alcoholism, and drug addiction, and three types of chronic pain: facial pain, myofascial pain, and fibromyalgia. A fourth group, a heterogeneous group of other pain, was used as a comparison group.
Ninety one patients with chronic pain, age range 20-60, were consecutively recruited from the outpatient clinics of a rehabilitation hospital and a general hospital. Patients were given four measures for completion at evaluation: Childhood History Questionnaire; Childhood Traumatic Events Scale; McGill Melzack Pain Questionnaire; Pain Disability Index. Chi-square was used to test significant differences among four pain groups on sexual, physical, and verbal abuse; alcoholism; drug dependence; medications; major upheaval, childhood illness, death of a family member or friend, and separation or divorce of parents. Logistic regression was used to predict membership in the four pain groups.
All pain groups had a history of abuse exceeding 48%: fibromyalgia, 64.7%; myofascial, 61.9%; facial, 50%; other pain, 48.3%. All groups had a history of family alcohol dependence exceeding 38%, and a history of drug dependence ranging from 5.8 to 19.1%. A combined history of pain, child physical abuse, and alcoholism was prevalent in 12.9 to 35.3%. Logistic regression showed patients who were female, with an alcoholic parent, using non-narcotic drugs were more likely to be members of the facial, myofascial, and fibromyalgia groups.
Child traumatic events are significantly related to chronic pain. Since the problem of child abuse is broader than physical and sexual abuse, health and rehabilitation agencies must shift from individualized treatment to interdisciplinary treatment of the family and patient.
There is limited research on the connection between the Holocaust and chronic pain, despite evidence suggesting that medical and psychological sequelae are common in survivors. The goals of this study were: (1) to define Holocaust survivors' (n = 33) chronic pain characteristics as manifested 50 years after the war, (2) to compare survivors with controls (n = 33) who did not experience World War II atrocities, and (3) to investigate the connection between past trauma and chronic pain. Data were collected through questionnaires that included a detailed medical and pain history, visual analog scale (VAS), McGill Pain Questionnaire (MPQ), Beck Depression Inventory (BDI), Symptom Check List-90 (SCL-90), and Pain Disability Index (PDI). A comparison of variables between the two groups was conducted using multivariate analysis of variance (MANOVA) and ANOVA, and canonical discriminant analysis. Results showed that Holocaust survivors reported higher pain levels (73 +/- 18 vs. 56 +/- 21; P < 0.005), more pain sites (4.5 6 2.8 vs. 2.7 6 1.4; P < 0.05), and significantly higher depression scores (17.6 +/- 8.4 vs. 9.2 +/- 4.6; P < 0.001); they tended to utilize more medical services (5.9 +/- 3.0 vs. 5.1 +/- 2.8). Nonetheless, survivors did not regard themselves more disabled as compared with controls. They reported a higher activity level as measured by walking distance capacity, and spent significantly fewer hours resting (4.3 +/- 3.6 vs. 7 +/- 4.6; P < 0.05). This paradoxical combination of high pain intensity, moderate to severe depression, and high activity level characterizes Holocaust survivors' chronic pain. It is conceivable that by remaining active Holocaust survivors fight back their pain, distress, and depression. These findings suggest that Holocaust atrocities affect survivors' chronic pain even years later.
Considerable evidence suggests that a self-reported history of physical and/or sexual abuse is more frequently reported among chronic pain populations and is associated with poorer adjustment to pain. However, previous research has typically included patients seeking treatment for pain, whereas few population-based studies have explored the association between abuse history and pain. This purpose of this study was to examine the association between self-reported history of sexual or physical abuse and recent pain complaints, health-related variables, and psychological disturbance among a nonclinical sample of young adults.
Subjects were 426 (275 female, 151 male) college students who completed a series of questionnaires assessing abuse history, recent pain, health care utilization, perceived health, and psychological variables.
Females reported a positive history of abuse (PHA) more frequently than males (43.5% vs. 23.8%), and females reported significantly higher rates for all types of abuse except physical abuse during childhood (p < 0.05). PHA subjects reported experiencing pain in more sites and pain of higher severity over the past month compared to subjects with a negative history of abuse (NHA) (p < 0.05). PHA subjects also reported more health care utilization and greater psychological disturbance, including depression, somatization, negative temperament, and higher levels of catastrophizing (p < 0.05). Interestingly, when somatization and depression scale scores were used as covariates, group differences in pain complaints and health care utilization became nonsignificant (p > 0.10).
These findings suggest that a self-reported history of physical or sexual abuse is associated with increased pain complaints, health care utilization, and psychological disturbance even among young adults from a nonclinical population. Moreover, the association between abuse and pain complaints appears to be moderated at least in part by the higher levels of somatization and depression observed in the PHA group.
This study examines the relationship between a trauma history and emotional functioning in response to a chronic pain condition. We broadened the traditional study of trauma in chronic pain from sexual and physical abuse to include a variety of traumatic events and experiences that occurred not only during childhood, but during adulthood as well. Seventy‐three (51% female, 60% lower back) chronic pain patients were administered the Trauma History Questionnaire (Green, B.L., Trauma History Questionnaire. In B.H. Stamm (Eds.), Measurement of Stress, Trauma and Adaptation, Sidran, Lutherville, MD, 1996, pp. 366–369), the Multidimensional Pain Inventory (Kerns, R.D., Turk, D.C. and Rudy, T.E., The West Haven‐Yale Multidimensional Pain Inventory (WHYMPI), Pain, 23 (1985) 345–356), The Beck Depression Inventory (Beck, A.T., Ward, C.H., Mendelson, M., Mock, J. and Erbaugh, J., An inventory for measuring depression Arch. Gen Psychiatry, 4 (1961) 561–571), and the Pain Anxiety Symptoms Scale prior to starting a multidisciplinary pain program. We hypothesized that high levels of emotional distress and anxiety would differentiate patients with a substantial history of trauma from those without, while levels of pain severity and disability would not. A MANOVA revealed a significant Trauma Group (low vs. high) by Gender interaction for the dependent variables, which included both measures of emotional distress and pain severity and disability. Univariate tests showed that the interaction was significant only for emotional distress variables and not for pain severity and disability. Further, the multivariate effect of Trauma Group and the univariate effects for emotional distress variables were significant only among men. Results indicate that a substantial history of trauma may detrimentally impact a chronic pain patient's ability to manage their pain effectively, particularly among men.
Although considerable attention has recently been devoted to explaining why depression is a frequent concomitant of chronic pain, little empirical work has been conducted to test predictions based on these models. The present study was designed to test a cognitive-behavioral mediation model of pain and depression that proposes perceived reduction in instrumental activities along with a decline in perceptions of control and personal mastery are necessary prerequisites for the development of depressive symptomatology in pain patients. According to this model, in contrast to alternative models, the presence of pain is not sufficient condition for the subsequent development of depression. This model was tested and confirmed through the application of structural modeling with latent variables. Specifically, the direct link between pain and depression was found to be non-significant, however, measures of perceived life interference and self-control were found to be significant intervening variables between pain and depression. These results provide the first empirical demonstration that psychological mediators may be involved in the development of depression secondary to chronic pain. The findings of this study are contrasted with single-factor models that postulate both chronic pain and depression as resulting from a common cause.
This study addressed two issues concerning the theoretical and clinical relevance of depression to chronic pain: (a) whether reliable differences among depressed, mildly depressed, and nondepressed chronic pain patients could be identified and (b) whether depression influenced participation in or outcome following a rehabilitation program. To address the first issue, four theoretical constructs (pain severity, support from significant others, instrumental activities, and coping skills) were measured by multiple scales. Multivariate analyses of each construct revealed significant differences between the three groups on instrumental activities and coping skills, with more depressed individuals reporting lower levels of functioning. There was a tendency for depressed individuals to report less support. An analysis of the second issue revealed that depressed pain patients showed a greater tendency to drop out of treatment. Outcome did not vary with depression among treatment completers. The results reveal the need to consider a cognitive–behavioral model of depression secondary to chronic pain.
The extent to which depression and chronic pain are associated remains a controversial issue which empirical studies have failed to resolve completely. A critical evaluation of the relevant literature provides some support for an association between the two syndromes and suggests that coexisting pain and depression may be a final common presentation reached by a number of pathways. Common conceptual and methodological problems that have prevented more definitive conclusions from being drawn are discussed. Current biological and psychological models of the mechanisms by which chronic pain and depression may interact are summarized, and suggestions for future research are made.
The previously noted association between a history of childhood sexual abuse and an unusual number of medical complaints in adult women was examined in this study. In total, 60 women, 27 of whom had and 33 of whom had not been sexually abused as children, completed questionnaire measures of their medical complaints. Results revealed that the women with a history of sexual abuse had significantly more frequent complaints of a variety of medical problems, some of which, such as pelvic pain, have been noted in previous literature, and some of which, such as asthma, represent new findings.
The present study examined the relationship between psychological factors and pain in order to assess the contribution of emotional disturbance to the perpetuation of pain. A group of 163 chronic pain suffers in multiple settings was compared with 81 control subjects on measures of personal history antecedent to pain onset, as well as on measures of current emotional disturbance. In addition, these psychological variables were examined for their associations with subjectively rated pain intensity. Overall, pain was found to be related to more current depression and less current life satisfaction, but was not associated with most of the personal history variables examined. These results suggests that emotional disturbance in pain patients is more likely to be a consequence than a cause of chronic pain. The dangers of routinely ascribing intractable pain to psychological causation are discussed in the light of these findings.
The present study investigated the relationship between the severity of depressive symptoms and various qualitative and quantitative aspects of pain reported by chronic pain patients. The sample consisted of 73 patients from a heterogeneous pain population admitted to the Victoria General Hospital Pain Management Unit. Patients completed a comprehensive pain evaluation battery that included the Beck Depression Inventory (BDI) and the McGill Pain Questionnaire (MPQ). They rated their loss of desire and ability for various social and recreational activities, and the intensity of their pain for 8 periods of a typical day. Multivariate analyses of variance were used to assess the sensory, affective, and evaluative indices of the MPQ, daily pain intensity ratings, and reported impairment of activities of non-depressed, mildly depressed and moderate/severely depressed patients. The results indicate significant relationships between the degree of depression and (a) the number of sensory descriptors endorsed on the MPQ; (b) pain intensity ratings in the late evening and at bedtime; and (c) reported loss of ability for social and recreational activities. Depression is related to loss of desire for activity in women, but not in men. A discriminant analysis suggests that depressed and non-depressed pain patients can be distinguished with 78% accuracy on the basis of their MPQ Sensory scores, reported loss of ability for activities, and global pain ratings at late evening and bedtime. The findings are discussed in terms of their implications for research as well as for the assessment and treatment of chronic pain patients.
Previous studies of pain behavior in patients with chronic pain have shown that depressed patients exhibit more pain behavior than nondepressed patients. This study sought to extend these findings and to examine the possible causes of the observed differences.
Patients completed the short form of the Beck Depression Inventory, and their pain behavior was simultaneously rated by themselves and trained observers.
Subjects were 37 inpatients in a chronic pain program.
Both depressed and nondepressed subjects rated themselves as exhibiting more pain behavior than did nurse ratings. While nurses rated pain behaviors as similar among the depressed and the nondepressed groups, patient ratings indicated significantly more pain behavior among depressed than nondepressed patients.
These results suggest that cognitive factors may influence self-ratings of pain behavior by depressed subjects.
To examine the correlation between childhood psychological trauma(s) and refractory back pain in patients with and patients without prior spine surgery.
Retrospective chart review survey of 101 consecutive patients who had undergone multidisciplinary evaluation for refractory back pain.
Private practice, tertiary care spine center.
Each psychological risk factor (physical abuse, sexual abuse, emotional neglect or abuse, abandonment, and chemically dependent caregiver) was rated as present or absent. Spinal pathology was graded as significant or not significant.
There were 56 patients with failed back surgery syndrome, 28 men and 28 women, with a mean age of 43 and mean pain duration of 45 months. There were 45 patients with no prior surgery, 26 men and 19 women, with a mean age of 43 and mean pain duration of 33 months. In the failed back surgery syndrome group, 27 (48%) had three or more risks and 39 (70%) had two or more. When the 12 patients with significant pathology are not considered, 24 of the remaining 44 (55%) patients had three or more risks. In the group with no prior surgery, 26 (58%) had three or more risks and 38 (84%) had two or more. When the five patients with significant pathology are not considered, 24 (60%) had three or more risks.
Multiple childhood psychological traumas may predispose a person to chronic low back pain. In patients in this setting with refractory low back pain with or without prior lumbar spine surgery, three or more childhood psychological risk factors are prevalent, especially in patients with minimal structural pathology.