To evaluate the role of physical and/or sexual abuse on chronic pain symptoms and health care utilization in women, 104 consecutive female patients presenting to a multidisciplinary pain center for management of chronic pain were surveyed. Outcomes included a measure of sexual or physical abuse history (Drossman Sexual-Physical Abuse Survey), and measures of anxiety, health care utilization, substance abuse, and somatic symptoms. Forty-eight percent of the sample reported a history of physical abuse (PA) or sexual abuse (SA). Forty percent of the abused patients reported both PA and SA and the remainder reported SA (37%) or PA (23%) alone. The women who reported abuse had increased pain, physical symptoms, anxiety symptoms, and mental health care utilization compared to nonabused women. The women who reported abuse were also more likely to smoke and abuse street drugs. Women who reported both PA and SA were more likely to report head pain when compared to those who reported only PA or SA. Given the impact of abuse, particularly SA, on the presentation of chronic pain, queries regarding abuse should become a routine component of the patient interview. Abused patients should be referred to mental health care practitioners as a component of successful pain management if unresolved issues persist.

http://www.ncbi.nlm.nih.gov/pubmed/10641468
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Phoenix

A guy opens the front door and sees a snail on his doorstep. He picks up the snail and throws it across the street in a neighbor's yard. A year later, the guy opens the front door and the same snail is on his doorstep. The snail says, "What the f*ck was that about?"