Child Maltreatment in High Income Countries (4)

In the last post, we saw some of the difficulty researchers face in attempting to determine if child abuse increases the rate of chronic pain in adults.  (Symptoms other than pain are not as well studied.)  It is not uncommon for studies to have results that appear to conflict (1).

Another idea to consider that may account for some complexity and conflict is that child abuse is associated with an increased risk of abuse during the adult years.  This later maltreatment may be a significant source of pain.  Still another idea applies to the subset of people who are abuse survivors and who present themselves to a medical clinician with pain.  It may be true in that group that addressing child abuse consequences via counseling will be more beneficial than treating the pain without the counseling.  A study presented at the recent American Psychosomatic Society meeting (not yet published) did show this in fibromyalgia patients and this result clearly matches my clinical experience.  Even here we need to be careful in our interpretation, since it could be that the support and attention provided by counseling was of key importance, and not the fact that much of the counseling focused on child abuse consequences.

This is why I greatly admire my colleagues who attempt to clarify these many possible interpretations and biases through research.  I will keep my readers up to date as new research becomes available.

1. Gilbert R et al.  Burden and consequences of child maltreatment in high-income countries.  Lancet 373, Issue 9657, 3 January 2009-9 January 2009, Pages 68-81.