Impact of an abuse history on the health outcomes among blacks and whites with chronic pain

Abstract

The association between physical and sexual abuse among men and women with chronic pain is under-examined. We hypothesized that the pain experience for men and women with an abuse history differed according to abuse type and age at which abuse occurred. A prospective cohort study involving chronic pain patients 18-50 years at a tertiary care pain center was conducted. Data on sexual and physical abuse (Drossman Abuse Questionnaire; DAQ), pain severity, functioning and PTSD were collected. Participants completing the DAQ were included in analyses (N 165; 91% response). Most subjects were women (64%), educated (68% high school), in a long-term relationship (51%), employed (59%), and White (50%). Prior analysis identified six 3-item abuse factors (a .77-.91): sexual molestation, sexual penetration (rape), and physical abuse in both childhood and adulthood. Decreased general health was associated only with rape in childhood (p .03). However, decreased mental health was associated with molestation, penetration, and physical abuse in childhood (p .02; .004; .01 respectively) and adult physical abuse (p .05). While increased sensory pain was associated only with physical abuse in adulthood (p .04); affective pain was associated with all abuse scales in childhood and molestation and physical abuse in adulthood; though molestation in childhood was predictive only of higher affective pain for men (p .03). Decreased functioning was predicted by childhood rape (p .03). Regarding PTSD, men with childhood or adulthood molestation (p .01; p .008) and penetration (p .02; p .03) reported more PTSD than non-abused men. Overall an interaction between pain experiences and abuse patterns was identified. Pain is perceived more emotionally by abused people. In some measures this is more true for men than women. These findings support the clinical need to enquire about an abuse history from both men and women. Further research should evaluate pain’s affective component in abused men and women.