Interpersonal Violence Exposure and Chronic Pain in Adult Sickle Cell Patients

2017 ◽  
Vol 35 (3-4) ◽  
pp. 924-942 ◽  
Author(s):  
Julian D. Ford ◽  
Damion J. Grasso ◽  
Sasia Jones ◽  
Teresa Works ◽  
Biree Andemariam
Keyword(s):  
Chronic Pain ◽  
Sickle Cell ◽  
Interpersonal Violence ◽  
Emotional Abuse ◽  
Violence Exposure ◽  
Health Care Disparities ◽  
Mental Health Problems ◽  
Psychological Trauma ◽  
Opiate Use ◽  
History Of

Almost half of sickle cell disease (SCD) patients develop chronic, debilitating physical pain with uncertain genesis for which they primarily receive opiate-based palliative treatment. Psychological trauma exposure, especially interpersonal victimization, has been linked to the perception of pain in several medical diseases, but has yet to be examined in SCD patients. This study examines self-reported chronicity of pain and use of prescribed opiates in 50 adult SCD patients with and without a history of interpersonal violence exposure. We conducted a retrospective chart review of 50 consecutive SCD patients seen for medical care in an adult subspecialty hematology clinic. Data collected included demographics, opiate use, pain chronicity, and measures of anxiety, depression, and interpersonal violence exposure. Sixty-eight percent of patients reported past interpersonal violence exposure. The mean number of types of interpersonal violence exposure, including physical, sexual, or emotional abuse, was 2.76 ( SD = 1.63). SCD patients with a history of interpersonal violence exposure were almost five times more likely to report chronic pain and more than six times more likely to report use of opiate-based medications on a daily basis compared with SCD patients with no history of violence exposure. Depression and anxiety symptoms were associated with violence exposure, but did not account for the relationship between violence exposure and chronic pain or prescribed opiate use. Screening and assessment of exposure to interpersonal violence may be useful in addition to screening for mental health problems in the management of chronic pain with adults diagnosed with SCD. Such screening may contribute to addressing health care disparities given the preponderance of SCD patients who are of African American ethnoracial background.

Chronic Pain Is An Independent Predictor of Lower 6 Minute Walk Distance In Patients with Sickle Cell Disease: Results From Walk-PHaSST Study

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2658-2658
Author(s):  
Lakshmanan Krishnamurti ◽  
Ruchika Goel ◽  
Oswaldo Castro ◽  
Robyn J. Barst ◽  
Erika Berman Rosenzweig ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Exercise Capacity ◽  
Sickle Cell ◽  
Acute Pain ◽  
Research Funding ◽  
History Of ◽  
Pain Crisis ◽  
The Mean ◽  
Minute Walk Distance ◽  
Minute Walk

Abstract Abstract 2658 Introduction: Six minute walk distance (6MWD), is a measure of exercise capacity commonly used as an endpoint in pulmonary hypertension (PH) clinical trials. Many patients with sickle cell disease (SCD) have acute pain crises or chronic pain syndromes that impair their quality of life. While patients with SCD who are undergoing screening for PH are generally screened in steady state, i.e., when they have not had a recent pain crisis, the impact of chronic pain on exercise capacity in this group of patients has not been previously evaluated. Methods: walk-PHaSST was a multi-center screening study designed to identify subjects with SCD at increased risk for symptomatic PH, defined by a tricuspid regurgitant velocity (TRV) ≥ 2.7 m/sec and 6MWD between 150–500 meters, for enrollment in a double-blind placebo controlled trial of sildenafil. The primary endpoint was the change in 6MWD after 16 weeks of treatment. We examined the relationship between subjects' self-reported acute and chronic pain and baseline 6MWD in the screened SCD patients in walk-PHaSST. Results: For 90% of subjects, the information about pain was reported by the patient or parent/family member. Documentation of pain management and utilization of services was verified from medical records in 10% of subjects. Ninety four percent of all subjects reported having a history of acute sickle cell pain crises; 6% reported never having had an acute pain crisis. For the subjects who reported a history of acute pain crises, the ‘typical’ acute pain rating on a scale of 0 to 10 was ≥ 7 (maximum 10) for 77% of this subset of subjects. A total of 342 (50%) subjects reported not having had any pain crises in the preceding week. Of 720 subjects screened medical history and 6 MWD was available in 673 patients. Of these 633 (94%) subjects did not report having had a pain crisis requiring an emergency department visit or hospitalization in the preceding week. A total of 39% of subjects reported chronic sickle cell related pain; no rating was reported for chronic pain. 88% of patients reported using medications for pain control while 15% reported using non-drug therapy including physical therapy in 3%, alternative therapy in 2%, acupuncture in 2% and hypnosis in < 1% of patients. The mean 6MWD for the screened population was 439 meters (median 438 m, range 123–713 m). A total of 171/673 (26%) subjects had a 6MWD >500 meters, which was above the screening cut-off for enrollment in the main interventional trial. By univariate analysis, subjects reporting chronic pain had a significant lower odds ratio for walking > 500 meters (OR 0.637, 95% C.I 0.44–0.99); a similar observation was seen with those subjects with a history of acute pain crises (OR 0.47, 95% C.I 0.24–0.91). Multivariable logistic regression analysis revealed a significant inverse relationship between chronic pain but not acute pain and 6MWD after adjusting for age, TRV, gender, hematocrit and smoking history (See Table 1). The mean 6MWD decreased by 27 meters with self reported chronic pain after adjusting for TRV, age, gender, hematocrit and 6MWD. Conclusions: TRV is a known predictor of 6MWD. However, these data suggest that patient self reported sickle cell related chronic pain is also an independent predictor of 6MWD. This relationship raises interesting questions about the potentially confounding effects of pain on exercise capacity as assessed by the 6MW test. Further study is warranted to investigate an association between chronic pain and exercise capacity in SCD as well as exploration of appropriate endpoints for future clinical trials in patients with SCD and suspected symptomatic PH. Disclosures: Barst: Pfizer: Consultancy, Research Funding. Rosenzweig:Pfizer: Research Funding. Badesch:Pfizer: Honoraria, Research Funding. Hassell:Novartis: Research Funding.

Non-Cardiopulmonary Factors Affecting the Six-Minute Walk Distance in Patients with Sickle Cell Disease: Results From the Walk-PHaSST Study

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1074-1074 ◽  
Author(s):  
Ruchika Goel ◽  
Kathryn L. Hassell ◽  
Roberto F Machado ◽  
Robyn J. Barst ◽  
Nancy Yovetich ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
P Value ◽  
Cell Disease ◽  
Walk Distance ◽  
Factors Affecting ◽  
History Of ◽  
Minute Walk Distance ◽  
Minute Walk

Abstract Abstract 1074 Non-Cardiopulmonary Factors Affecting the Six-Minute Walk Distance in Patients with Sickle Cell Disease: Results from the Walk-PHaSST Study. INTRODUCTION: The six-minute walk (6MW) test is frequently used to assess exercise capacity. Patients with sickle cell disease (SCD) can have decreased 6MW distance (6MWD) compared to controls. The 6MWD in conjunction with the TR-jet velocity (TRV) and NT-proBNP have recently been proposed to have a greater predictive value for screening SCD patients suspected of having pulmonary hypertension (PH) than TRV alone. (Parent et al, NEJM, 365; 1, 2011 365 (1):44–53). The American Thoracic Society guidelines recommend caution in controlling for sources of variability in the 6MWD (Am J Respir Crit Care Med 166. 111–117, 2002). Age and height are known confounders of the 6MWD. However, non-cardiopulmonary factors including skeletal-mechanics and pain may also impact the 6MWD. AIM: This study explores whether non-cardiopulmonary factors affect the 6MWD in SCD patients. METHODS: We analyzed data from subjects screened for the walk-PHaSST trial. Walk-PHaSST was a multi-center, placebo-controlled, double-blind, 16-week trial evaluating the safety and efficacy of oral sildenafil for the treatment of Doppler-defined PH (TRV '2.7m/s) in subjects with SCD aged >12 years. The primary endpoint in the trial was change in 6MWD. During screening, subjects were evaluated by self-reported medical history, physical examination, blood sampling, echocardiography and 6MWD. Univariate and multivariable linear regression was performed. A two sided p value <0.05 was considered significant. RESULTS: Of the 673 subjects screened, 671 had a 6MW test. The median (inter-quartile range) of 6MWD was 438m (503 – 381m = 122 m). On univariate analysis, there was no statistically significant effect of the SCD genotype on the 6MWD (p=0.26). Further, when combining the severe genotypes (HbSS and HbSβ0 thalassemia) vs the less severe genotypes, there was no significant difference in the 6MWD (p=0.22). By multivariable linear regression (Table 1), after adjusting for age, gender and TRV, the presence of the following (self-reported by subjects) were independently associated with an estimated decrease in the 6MWD: a) chronic pain (n = 260/671, 38.9%) by 24.3m (95% CI: 9.1–39.4m, p-value <0.01), b) history of avascular necrosis (AVN) of the hip (N =127/671, 18.9%) by 27.8m (95% CI: 9.2–46.4m, p-value <0.01), and c) osteopenia (N = 46/671,6.9% ) by 31.2m (95% CI: 2.7.-59.6m, p-value <0.05) There were no significant two-way interactions between chronic pain, AVN of the hip and/or osteopenia. History of leg ulcers, osteomyelitis and rheumatoid arthritis were not significant predictors of the 6MWD. DISCUSSION: In this multi-center study of patients with SCD, history of self-reported: 1) chronic pain 2) AVN of the hip and 3) osteopenia were independently associated with decreased functional capacity (as assessed by the 6MW test), after adjusting for age, gender, and TRV. While the 6MWD in patients with SCD is significantly related to cardiac function (i.e., PH and LV diastolic dysfunction), the potential effects of pain, osteonecrosis and osteopenia on 6MWD suggest that if using the 6MW test as the primary endpoint in future trials, one should consider documentation of the presence of these factors and use a stratified randomization based on a composite of these non-cardiopulmonary variables. Disclosures: Hassell: NIH:. Gladwin:Patents filed related to treating hemolysis.: Patents & Royalties.

Comparison of Scores for Abused and Nonabused Young Adults on the Psychological Trauma and Resources Scale

2004 ◽  
Vol 94 (2) ◽  
pp. 687-693
Author(s):  
Sandra R. Stader ◽  
George R. Holmes ◽  
George F. McNulty ◽  
Angela Q. Forand ◽  
deRosset Myers
Keyword(s):  
Emotional Support ◽  
Emotional Abuse ◽  
Traumatic Events ◽  
Empirical Support ◽  
Psychological Trauma ◽  
Psychological Resources ◽  
Self Talk ◽  
Abuse And Neglect ◽  
Adolescents And Adults ◽  
History Of

The Psychological Trauma and Psychological Resources Scale has been developed to identify adolescents and adults who have experienced traumatic events, i.e., physical, sexual, or emotional abuse and neglect. The scale also attempts to identify the presence of compensatory or resource factors such as social support that may serve to ameliorate the effects of traumatic events. 98 college participants who reported a history of abuse were compared with 464 nonabused students on the seven subscales. As predicted, the abused participants reported significantly more incidents of abuse and neglect than the nontraumatized group. In addition, the abused group reported receiving less emotional support, and they were less likely to use positive self-talk as a way to decrease emotional distress. These results provide empirical support for using the Psychological Trauma and Psychological Resources Scale to identify individuals with a history of abuse. Findings underscore the importance of assessing resource variables that may moderate the effects of abuse.

Childhood Domestic Violence as an Ancestor for Adulthood Mental Health Problems: Experiences of Jordanian Women

2020 ◽  
Vol 28 (4) ◽  
pp. 390-395
Author(s):  
Hanan Al-Modallal ◽  
Hasan Al-Omari ◽  
Shaher Hamaideh ◽  
Tariq Shehab
Keyword(s):  
Mental Health ◽  
Childhood Abuse ◽  
Emotional Abuse ◽  
Mental Health Problems ◽  
Women's History ◽  
Health Problems ◽  
Abused Women ◽  
Childhood Neglect ◽  
Wilks Lambda ◽  
History Of

This study was conducted to explore the relationship between women’s history of experiencing different types of abuse during childhood and development of mental health problems in adulthood. A convenience sample of 409 women recruited from health care centers in Jordan provided data for the study. One-way between-groups multivariate analysis of variance was implemented. Results indicated absence of statistically significant differences in mental health problems between physically abused and sexually abused women compared to their counterparts. Further, a statistically significant difference in mental health was found between women who experienced emotional abuse and childhood neglect compared to their counterparts (Wilks’ lambda for emotional abuse = .914, p < .0001; Wilks’ lambda for childhood neglect = .83, p < .0001). Between-groups comparisons using Bonferroni adjustment indicated that all dependent variables (depression, anxiety, stress, and self-esteem) differed significantly between emotionally and nonemotionally abused women and between neglected and nonneglected women. It was concluded that not all childhood abuse experiences lead to long-term impacts on women’s mental health. However, mental health consequences of childhood abuse may alter women’s obligations toward family, children, and home. Therefore, efforts directed toward assessing women’s history of childhood abuse are very important especially for those who are starting a marital relationship.

scholarly journals Head injury in asylum seekers and refugees referred with psychological trauma

2016 ◽  
Vol 3 ◽  
Author(s):  
S. M. Doherty ◽  
R. Craig ◽  
M. Gardani ◽  
T. M. McMillan
Keyword(s):  
Mental Health ◽  
Head Injury ◽  
Asylum Seekers ◽  
Mental Health Problems ◽  
Psychological Trauma ◽  
Mental Health Clinicians ◽  
Trauma Service ◽  
History Of ◽  
Preliminary Study ◽  
Asylum Seekers And Refugees

Objective.Individuals who seek asylum are frequently fleeing violent persecution and may experience head injury (HI). However, little is known about the prevalence of HI in asylum seekers and refugees (ASR) despite the potential for HI to significantly affect cognitive and emotional functioning and to compromise asylum outcomes. This preliminary study investigates the prevalence of HI in ASR referred to a complex psychological trauma service.Method.Participants were 115 adult ASR referred to a community psychological trauma service with moderate to severe mental health problems associated with psychological trauma. They were screened for a history of HI using a questionnaire developed for the study. Interpreters were used when required.Results.The overall prevalence of HI was 51%. At least 38% of those with HI had a moderate–severe HI that could cause persisting disability. In 53% of those with HI, the cause was torture, human trafficking or domestic violence. Repeat HI can have cumulative effects on function; it was common, and was reported in 68% of those with HI. An injury to the head was not known to mental health clinicians prior to screening in 64% of cases.Conclusion.The emotional and cognitive consequences of HI in ASR may increase the vulnerability of this disadvantaged group, and can be associated with neurobehavioural problems affecting daily life and may compromise asylum outcomes. Routine screening for HI in ASR is needed, as are links to neuropsychology and brain injury services for advice, assessment and intervention.

scholarly journals Perceptions of nonopioid treatment for pain in a homeless population

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Kristina A. Fraser ◽  
Harvard Nguyen ◽  
Suhhyun Kim ◽  
Flora Park ◽  
Joshua Bernal ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Massage Therapy ◽  
Homeless Population ◽  
Treatment Modalities ◽  
Complementary Treatment ◽  
Opiate Use ◽  
History Of ◽  
Willingness To Use ◽  
Complementary And Alternative

Abstract Background Opioid abuse has developed into a public health emergency within the last decade because opioid medications, while addictive, are effective and commonly used for pain management. In 2016, over 42,000 deaths were attributed to opioids. Chronic pain affects about 50% of people experiencing homelessness in the US, and they have a higher overall rate of chronic pain than the general population; opioids are among the methods they might use to manage that pain. Complementary and alternative therapies for pain management have largely gone unexplored in the homeless population. Objectives To determine, among people experiencing homelessness, the willingness to use and current use of complementary and alternative treatments (physical and massage therapy, chiropractic treatments). A secondary objective was to investigate awareness and perception of osteopathic manipulative treatment (OMT) as a complementary treatment for chronic pain among the homeless population. Methods A 32 question survey was administered verbally to guests of True Worth Place Homeless Shelter in Fort Worth, Texas in three 4 hour sessions from February 2019 to April 2019. If participants gave verbal consent, a researcher read the questionnaire, one question at a time, and recorded the participant’s responses. The survey included queries for opioid and nonopioid treatment modalities (physical and massage therapy, chiropractic, and OMT) to assess the perception of and current use of each among the population. Appropriate nonparametric statistical analysis was conducted to assess significance and correlations among the treatment groups. Results Of the 200 survey participants, 126 (91.3%) reported a history of opiate use for pain, but 136 (68.0%) believed that a nondrug pain intervention could better treat their pain. Additionally, 150 participants (75.0%) believed that regular manipulation, including OMT, would decrease their need for pain medications. Participants with a history of opioid use for pain were more likely to believe that the availability of regular manipulation, including OMT, at True Worth Place could decrease their need for pain medication (odds ratio=3.7143; 95% confidence interval=1.6122–8.5572; p=0.0009). Moreover, some participants (141; 70.5%) were already pursuing nondrug pain management modalities such as PT, massage therapy, and chiropractic care. The greatest barriers to receiving OMT were transportation and cost. Conclusions This survey study was conducted to determine whether a homeless population would be willing to use nonopioid treatment, particularly OMT, for chronic pain management. Results revealed both a willingness to use and a previous use of nonopioid treatments for pain, along with a high prevalence of opiate use. Despite limited exposure to OMT, this population reported being potentially willing to pursue manipulation, including OMT, as a complementary treatment for pain relief alongside opioids if readily available.

scholarly journals Clinical Guideline Highlights for the Hospitalist: Management of Acute and Chronic Pain in Sickle Cell Disease

2021 ◽  
Author(s):  
Charles D Pham ◽  
Duong T Hua
Keyword(s):  
Chronic Pain ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Pediatric Patients ◽  
Clinical Guideline ◽  
Target Population ◽  
Cell Disease ◽  
Release Date ◽  
History Of ◽  
American Society

GUIDELINE TITLE: American Society of Hematology 2020 Guidelines for Sickle Cell Disease: Management of Acute and Chronic Pain RELEASE DATE: June 19, 2020 PRIOR VERSION: Not applicable DEVELOPER: American Society of Hematology Guideline Panel on Sickle Cell Disease-Related Pain FUNDING SOURCE: American Society of Hematology TARGET POPULATION: Adult and pediatric patients with a history of sickle cell disease with acute and chronic pain.

How I Survived Emotional Abuse: A Narrative Study

2018 ◽  
Vol 1 (2) ◽  
pp. 250-269
Author(s):  
Siti Norzahra Yusof
Keyword(s):  
Coping Strategies ◽  
Emotional Abuse ◽  
Mental Health Problems ◽  
Parental Divorce ◽  
Female Respondent ◽  
Face To Face ◽  
Narrative Study ◽  
School Counsellors ◽  
History Of ◽  
Families With Children

Children of divorce are not new to society yet their coping strategies are overlooked. Different abuse histories warrant a unique combination of coping strategies to deal with memories of past abuse. Coping has been put forward as an important element in understanding the long-term functioning of individuals with a history of emotionally abuse. The aim of this study was to investigate the challenges faced by a child of divorced parents, the coping strategies adopted by the child and how these coping strategies affected her level of perceived stress and life satisfaction. By using a narrative study, a female respondent, aged 13 who had been victimised through parental divorce was interviewed. Face-to-face interview was conducted by employing unstructured questions. Thematic analysis was implemented to analyse the data. Major themes found were; internal and external challenges, as well as positive and negative strategies. The results revealed that the child experienced mental health problems such as depression and loneliness during her childhood as a consequence of parental divorce which is perceived as a huge stressor or challenge in her life event. She engaged in both problem-focused and emotion-focused coping – using active emotion-focused coping other than avoidant focused coping – which led to boosting satisfaction in her life. This study contributes to school counsellors in helping school children, as well as for Muslim families with children coping with emotional abuse.

History of Interpersonal Violence, Abuse, and Nonvictimization Trauma and Severity of Psychiatric Symptoms Among Children in Outpatient Psychiatric Treatment

2011 ◽  
Vol 26 (16) ◽  
pp. 3316-3337 ◽  
Author(s):  
Julian D. Ford ◽  
Kerry Gagnon ◽  
Daniel F. Connor ◽  
Geraldine Pearson
Keyword(s):  
Behavior Problems ◽  
Disruptive Behavior ◽  
Interpersonal Violence ◽  
Emotional Abuse ◽  
Psychiatric Treatment ◽  
Emotional Problem ◽  
Psychiatric Diagnoses ◽  
Disruptive Behavior Problems ◽  
Research Attention ◽  
History Of

In a clinical sample of child psychiatry outpatients, chart review data were collected for 114 consecutive admissions over a 1-year period at a Child and Adolescent Outpatient Psychiatry Clinic. Data included history of documented maltreatment, potentially traumatic domestic or community violence, neglect or emotional abuse, and noninterpersonal stressors as well as demographics, psychiatric diagnoses, and parent-rated child emotional and disruptive behavior problems. On a bivariate and multivariate basis, any past exposure to interpersonal violence—but not to noninterpersonal traumas—was related to more severe disruptive behavior problems, independent of the effects of demographics and psychiatric diagnoses. Noninterpersonal trauma and psychiatric diagnoses were associated with emotional problems; exposure to interpersonal violence appeared to partially account for this relationship despite not being independently associated with emotional problem severity. History of exposure to interpersonal violence warrants clinical and research attention as a severity marker and potential treatment focus in psychiatric outpatient services for children, particularly those with disruptive behavior problems.

scholarly journals Childhood maltreatment and its mental health consequences among Indian adolescents with a history of child work

2020 ◽  
Vol 54 (5) ◽  
pp. 496-508
Author(s):  
Rakesh Pandey ◽  
Shulka Gupta ◽  
Aakanksha Upadhyay ◽  
Rajendra Prasad Gupta ◽  
Meenakshi Shukla ◽  
...  
Keyword(s):  
Mental Health ◽  
Childhood Maltreatment ◽  
Emotional Abuse ◽  
Mental Health Problems ◽  
Psychiatric Symptoms ◽  
Well Being ◽  
Health Consequences ◽  
Child Work ◽  
Indian Adolescents ◽  
History Of

Objectives: Although the prevalence and mental health consequences of childhood maltreatment among adolescents have been studied widely, there are few data addressing these issues in Asian lower middle–income countries. Here, we assessed the prevalence and types of childhood maltreatment and, for the first time, examined their association with current mental health problems in Indian adolescents with a history of child work. Methods: One hundred and thirty-two adolescents (12–18 years; 114 males, 18 females) with a history of child work were interviewed using the Child Maltreatment, Conventional Crime, and Witnessing and Indirect Victimisation modules of the Juvenile Victimization Questionnaire. Potential psychiatric diagnoses and current emotional and behavioural problems were assessed using the culturally adapted Hindi versions of the Youth’s Inventory–4R and the Strengths and Difficulties Questionnaire, respectively. Results: A large proportion of the sample reported childhood abuse or neglect (83.36%), direct or indirect victimisation (100%) and experienced symptoms of one or more psychiatric disorders (83.33%). Of the most common maltreatment types, physical abuse was present for 72.73% (extra-familial 56.25%, intra-familial 42.71%), emotional abuse for 47.7% (extra-familial 74.6%, intra-familial 12.9%), general neglect for 17.4% and unsafe home for 45.5% of the adolescents. All these maltreatment types were associated with poor mental health, with emotional abuse showing the strongest and wide-ranging impact. Conclusions: Indian adolescents with a history of child work are at an extremely high risk of extra-familial physical and emotional abuse as well as victimisation. They also experience a range of psychiatric symptoms, especially if they suffered emotional abuse. There is an urgent need for routine mental health screening and to consider emotional abuse in all current and future top-down and bottom-up approaches to address childhood maltreatment, as well as in potential interventions to ameliorate its adverse effects on mental health and well-being, of child and adolescent workers.

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