23: Adverse childhood experiences (ACEs) in the chronic pelvic pain population

Abstract

Adverse Childhood Experiences (ACEs), traumatic events occurring during childhood, are not well recognized in the gynecologic community but are associated with life-long deleterious effects. The objective of this study was to bridge the information gap regarding ACEs in the chronic pelvic pain (CPP) population by (1) describing ACE prevalence in women with chronic pelvic pain (CPP), and (2) comparing ACE prevalence in women with CPP to unaffected controls. This is a cross-sectional case-control study designed to examine the relationship of ACEs with CPP. Following IRB approval and written consent, patients diagnosed with CPP (n=60) were age-matched to controls (n=60). All participants completed validated measures to evaluate for presence any of the 11 ACEs (BRFSS ACE Module), as identified by the Center for Disease Control, during their initial clinic visit. The BRFSS ACE Module also sub-categorizes ACEs into abuse and household dysfunction. Significance was set at p<.05. The mean age of CPP women was 39.6 (±11.5) years, 52% were Hispanic (groups did not differ p>.05). We found that almost half (45%) of the CPP subjects had ≥5 ACEs, compared to 13% of controls (OR= 5.32; 95% CI 2.16-13.1); and found a strong logistic-regression relationship between number of ACEs and CPP (p<0.001) (Table 1). All categories of abuse were more prevalent in CPP patients compared to controls: physical (43% vs. 15%, OR=4.3; 95% CI 1.8-10.4; p=.001), verbal/emotional (62% vs 33%, OR=3.2; 95% CI 1.5-6.8; p=.003), and sexual (55% vs. 23%, OR=4.0; 95% CI 1.8-8.8; p<.001). Two categories of household dysfunction, substance abuse (45% vs. 25%, OR=2.5; 95% CI 1.1-5.3; p=.035) and witnessed domestic violence (35% vs 8%; OR=5.9; 95% CI 2.1-17.1; p<.001) were more prevalent in the CPP group (Table 2). CPP patients are likely to have high numbers of ACEs. This suggests that CPP symptomatology may, in part, be a manifestation of childhood exposures. In turn, it may require reconsideration of current clinical treatment, and a multi-disciplinary approach tailoring non-surgical and surgical management.View Large Image Figure ViewerDownload Hi-res image Download (PPT)