Sexual Abuse and Chronic Musculoskeletal Pain: Prevalence and Psychological Factors

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Abstract
We investigated the prevalence of a history of sexual abuse among patients with long-term musculoskeletal pain. Psychological factors associated with abuse and pain were also studied. First, the prevalence of abuse was determined based on self-report on a valid and reliable abuse questionnaire. Subsequently, a cross-sectional method, in which patients were categorized as abused or nonabused, was employed and responses to a battery of questionnaires compared. Seventy-five consecutive patients undergoing assessment for chronic musculoskeletal pain participated. These included Beck's Depression Inventory, the Coping Strategies Questionnaire, the Multidimensional Pain Inventory, the Uppsala Type A Behavior Questionnaire, the Pain and Impairment Rating Scale, as well as ratings of pain intensity. Thirty-eight percent of the women and 10% of the men reported some form of sexual abuse, usually during adulthood. A majority (77%) had disclosed the abuse to someone, but >85% did not believe that the abuse negatively affected their pain or sex lives. Abused women, relative to nonabused ones, had poorer scores on 27 of the 29 assessment variables. Abused female patients had significantly higher levels of depression, stress from daily hassles, affective distress, and more frequent negative responses from spouses, in addition to having lower levels of social activities, life control and effective coping for pain than did the nonabused female patients. These data extend the relationship between sexual abuse and pain to a Swedish population suffering from musculoskeletal complaints. Our findings suggest that intervention in the pain treatment setting may need to address further the problems of effective coping strategies and depression.