Lifetime physical and sexual abuse in chronic pain patients: psychosocial correlates and treatment outcomes.

PURPOSE: This study describes a subgroup of diagnostically heterogeneous chronic pain patients, with a lifetime history of physical and/or sexual abuse, who underwent a pain management programme. A battery of psychosocial and pain measures were assessed, as well as 1-year post-treatment socio economic outcomes. METHOD: The prevalence of a history of abuse was assessed via a semi-structured interview of 162 consecutive patients (112 females and 50 males) presenting for 4-8 weeks of treatment in an interdisciplinary, outpatient rehabilitation programme. Treatment outcome data were gathered immediately, 6 months and 1 year following discharge. The chronic pain patients with a history of abuse were compared to those without a history of abuse on several pre-treatment psychosocial variables--pain severity, psychological distress, DSM-IV Axis I comorbidity and health care utilization. Patient groups were matched on age, race, primary pain diagnosis, time in pain prior to treatment and gender. RESULTS: Results indicated that 61% of patients had a history of lifetime physical and/or sexual abuse. Rates of sexual, and combined sexual and physical, abuse across the lifespan were higher for women than for men. Abused patients had a greater number of psychiatric diagnoses than nonabused patients. Abused patients also reported greater affective distress, less perceived life control, and a greater number of ER visits in the 6 months prior to treatment than their nonabused counterparts. A model consisting of gender (female), a higher number of psychiatric diagnoses, and higher affective distress was found to be a sensitive and relatively accurate predictor of abuse history. Finally, analyses indicated that, despite having greater psychosocial risk factors during the pre-treatment period, chronic pain patients with a history of abuse benefited from treatment and maintained treatment gains to a degree similar to nonabused chronic pain patients. CONCLUSIONS: Chronic patients with an abuse history can successfully complete a rehabilitation programme if the programme is designed to treat their psychosocial distress. Moreover, this also carries over to treatment outcome. A history of abuse does not have to negatively impact long-term treatment outcomes in this population of chronic pain patients.

Olanzapine for the treatment of fibromyalgia symptoms.

Fibromyalgia is a chronic condition that is diagnosed primarily by the presence of generalized pain along with tenderness on palpation of certain body regions. Unfortunately, the pharmacological treatment of fibromyalgia remains problematic. Two patients are described who highlight the use of the atypical neuroleptic olanzapine for the control of symptoms related to fibromyalgia. Prior to the use of olanzapine, both patients had received a multitude of treatments, none of which greatly improved their ability to function in daily activities. With olanzapine, both patients reported a significant decrease in pain and marked improvement in daily functioning. In one case, the pain returned during a period of time when olanzapine was discontinued, an effect that was reversed when olanzapine was reintroduced. The paucity of serious side effects (i.e., extrapyramidal signs) with the atypical neuroleptic olanzapine strongly favors further exploration and use of this drug for the treatment of fibromyalgia symptoms.

Object relations and physical abuse: a TAT analysis.

Selected Thematic Apperception Test (Murray, 1943) stories of 39 physically abused children and a clinical group of 39 children with no recorded history of abuse were examined using the Social Cognition and Object Relations Scales (Westen, Lohr, Silk, Kerber, & Goodrich, 1985). As predicted, a history of physical abuse was associated with a more malevolent object world; a lower level capacity for emotional investment in relations and moral standards; and less accurate, complex, and logical attributions of causality in understanding human interaction. These impairments in object relations were manifest both as a typical level of functioning and as a propensity for more grossly pathological functioning. Results are discussed in terms of clinical and theoretical implications.

Object relations of sexually abused female subjects: a TAT analysis.

TAT stories of 17 sexually abused female subjects and a clinical group of 25 female subjects with no documented history of sexual abuse were analyzed using the Object Relations and Social Cognition Scoring System (Western, Lohr, Silk, Kerber, & Goodrich, 1985). Subjects ranged in age from 5 to 16 years. As predicted, mean scores on a measure of overall object relations were significantly different between groups. Specifically, the mental representations of subjects in the abuse group were characterized by more primitive and simple characterizations of people, more negative and punitive affect in their perceptions of the interpersonal world, an inability to invest in people and relationships in other than need-gratifying ways, and an inability to make sensible attributions of self and others. Abuse subjects also produced more pathological responses overall than did their nonabuse counterparts, indicating a tendency toward more extreme and immature functioning. These group differences were independent of any contribution of age and a measure of verbal productivity. Treatment and diagnostic implications are discussed.