A comparison of chronic pain patients and controls on traumatic events in childhood.

Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, Boston, USA. THAYER9378@aol.com

PURPOSE: The purpose was to examine the incidence of traumatic events in childhood, such as sexual and physical abuse, in a chronic pain group and a control group of hospital employees without chronic pain. METHOD: Ninety two patients with chronic pain, age range 20-62, were consecutively recruited from the outpatient clinics of a rehabilitation hospital and a general hospital. Ninety eight hospital employees, age range 20-62, were consecutively recruited from the employee health office of a rehabilitation hospital. All participants responded to nine questions related to sexual, physical and verbal abuse in childhood and completed the Childhood Traumatic Events Scale. A logistic regression with age, gender, sexual, physical, and verbal abuse, death of a family member, childhood illness, major upheaval before age 17, as independent variables were used to predict membership in the pain group contrasted with the control group. RESULTS: Child abuse was reported in the childhood history by 54.4% of the chronic pain group, compared with 21.4% of the control group. A logistic regression showed that after adjusting for gender and age, sexual and verbal abuse were statistically significant predictors of being a member of the pain group. Odds ratios were sexual abuse: 2.67, p < 0.05, CI 1.00-7.14. Verbal abuse: 4.39, p < 0.001, CI 1.93-9.97. A logistic regression was modelled to predict child abuse when gender was taken into account. The results of the logistic regression showed that pain was a significant predictor for sexual abuse after adjusting for gender and age: odds ratio 4.37, p < 0.001, CI 1.80-10.60. Gender was not a statistically significant predictor for sexual abuse, after adjusting for pain and age: odds ratio 2.92, p < 0.072, CI 0.91-9.42. CONCLUSIONS: A history of physical, sexual and verbal abuse is more likely to occur in a chronic pain group than in a control group of hospital employees. Although child abuse is reported to be as high as 25% in the general American population, the statistics for chronic pain patients are twice as high as in the general population. The mechanisms for abuse include age, gender, and early family environment.

Relationship between traumatic events in childhood and chronic pain.

Department of Psychiatry, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA 02114, USA.

PURPOSE: 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. METHOD: 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. RESULTS: 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. CONCLUSIONS: 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.

PMID: 10070600 [PubMed – indexed for MEDLINE]

Tension-type headache as the unique pain experience of a patient with congenital insensitivity to pain.

Département de Neurophysiologie Clinique, Centre Hospitalo-Universitaire, Pitié-Salpêtrière, Paris, France. ndanziger@hotmail.com

Congenital insensitivity to pain (CIP) is a rare clinical syndrome characterized by dramatic impairment of pain perception since birth and is generally caused by a hereditary sensory and autonomic neuropathy (HSAN) with loss of the small-calibre, nociceptive nerve fibres. We report the case of a 32-year-old woman with CIP and a presumptive diagnosis of HSAN type V, who experienced physical pain for the first and unique time in her life shortly after the sudden loss of her brother. This patient had sustained innumerable painless injuries during childhood, including bone fractures and severe burns. The only pain she ever felt consisted in an intense headache, which took place in a context of strong emotional overload and anxiety, 3 weeks after her younger brother died suddenly in a car accident. The description of this inaugural episode of headache fulfilled the diagnostic criteria of episodic tension-type headache. This case strongly suggests that the transcription of the grief of bereavement into physical pain may sometimes occur independently of the peripheral mechanisms of nociception and despite the lack of previous pain experience. In the light of recent experimental data showing that the same neural mechanisms that regulate physical pain may also control the expression of separation distress and the feeling of social exclusion, this unique case helps to better understand why some patients may feel physically hurt after the loss of someone they love.

PMID: 16154693 [PubMed – indexed for MEDLINE]