Some individuals with chronic pain problems present with a significant disparity between their complaints of often severe and unremitting pain and the relative lack of objective clinical evidence for a physical cause for their symptoms. Diagnosis and management pose major difficulties in such situations. These people often spend several years passing through the hands of specialists in one area of expertise and then another to no avail, and, on the way, they may collect physical problems arising out of the very investigations carried out on them and/or from the treatments given. Each period of hope is dashed by failure until...

The long-term effects of childhood events have come under sustained scrutiny ever since Freud. That, generally speaking, a relationship exists between adult affects and events in childhood is by now beyond question. However, the precise nature of this relationship remains problematic. Life-events research studies have indeed explained the power of negative life events in the etiology of morbidity in adults, and the loss-and-attachment literature has convincingly shown the impact in later life of separations from parents and other kinds of losses in childhood. The early death of a parent and depression in adulthood is an example of this. But not...

Engel postulated that growing up in abusive situations could lead to a life of chronic pain. In Chapter 1 the empirical evidence for his theory was reviewed. In this chapter a variety of patients whose cases involve some history of sexual abuse will be presented, and their clinical ramifications discussed. They were all seen at a free-standing pain clinic associated with a teaching hospital, and they all were referred to the clinic by physicians. They had already been thoroughly examined for organic causes for their unremitting pain, and they had already been tried on various courses of analgesic treatments. Many...

The idea that some sort of link exists between physical abuse and pain makes immediate sense. Physical abuse is inflicted with the intention of causing pain. Nevertheless, the long-term repercussions of childhood physical abuse on health are not as well researched as one might suspect. In preparing the first two chapters, this became apparent to me. Many reports tended to combine physical and sexual abuse in reporting outcome (Alper et al. 1993; Gross & Keller 1992; Kolko, Moser, & Weldy 1990). Other studies simply did not consider the health factor (Downs et al. 1992; Gross & Keller 1992). The review literature, of course,...

Any association between childhood neglect and subsequent painful condition does not readily lend itself to common sense. Nevertheless, both Engel (1959) and Szasz (1975) were aware of that possibility. It may be worth recalling that Szasz described pain as an emotion, as did Swanson (1984) many years later, and it is on that basis that some understanding can be developed for this relationship.

Engel, however, did not overtly acknowledge the role of parental neglect in the formation of pain symptoms. The closest he came to recognizing this phenomenon was his observation that children used pain to invite attention from distant...

This chapter addresses a question that is grossly under-reported in the pain literature, namely, pain in adult patients because of spousal or partner abuse or even the special issues confronted by the clinicians when a patient in an abusive relationship is identified.

Patients in abusive marital relations presenting with typical chronic pain problems who do present themselves at pain clinics perhaps go unrecognized. In many cases, however, an interesting association between abuse and the presenting pain complaints begins to unfold. Not infrequently, once the problem of abuse is identified and treated, pain itself recedes into the background. In my experience,...

Even a casual examination of the therapy literature on the victims of (mostly sexual) abuse reveals an incredible variety of interventions. They range from conventional group and behavioural therapies to music and art therapy to traditional individual and family therapy to imaginative use of video and hypnosis. Much of the voluminous literature is clinical, an exception being two controlled studies on the effectiveness of group therapy with victims of childhood sexual abuse. The literature can be broadly categorized by methods of intervention, namely, group approaches, family approaches, cognitive-behavioural approaches, individual approaches, and a pot-pourri of novel and innovative approaches. Because...

History of sexual abuse in our pain clinic is not actively sought, and there certainly is no effort spent on finding explanation for patientsʹ current difficulties in their childhood history of sexual abuse. Patients choose to reveal their past abuse of their own volition, sometimes after many months or even years of working with a therapist.

The decision to share information about sexual abuse is filled with terror and peril for the patient. Shame and guilt are ubiquitous in this population. Self-blame is almost universal. Hence, disclosing past abuse of any kind is an act of courage as well as...

A review of the treatment literature for survivors established that a wide variety of interventions were available and much experimentation with novel treatment methods was apparent. The literature also showed that not much outcome research was available to guide the therapist about the choice of treatment. Nevertheless, a group approach was by far the most preponderant form of treatment, and the sheer variety of group approaches employed to treat survivors was impressive. As was discussed in Chapter 1, there are many ways of explaining and understanding the abuse-pain relationship, and it is more than likely that methods of treatment based...

This chapter re-examines the major issues discussed throughout this volume. If there is a central message contained in this book, it is that childhood abuse and pain have a complex relationship. The task of identifying it is difficult in a medical setting. Yet, once it is identified and addressed, the outcome can be very positive, and, potentially, it can change the life of the patient for the better.

Pain remains probably the least known outcome of childhood abuse, and this is borne out by even a casual examination of the literature. The reason for this omission is that the much...