Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

The Chronic Pain of Intimate Partner Violence

As many as 5.3 million women in this country experience it each year

As many as 5.3 million women in this country experience some form of intimate partner violence (IPV) each year, with lifetime estimates as high as 40 percent. IPV includes a variety of abusive behaviors directed toward an individual who is or was in an intimate relationship with the offender. The Centers for Disease Control recently presented survey data from 2010, finding that 30 percent of women experience physical violence, 9 percent rape, 17 percent other “sexual violence,” and 48 percent psychological aggression from intimate partners over the course of their lives.

The obvious health effects from such abuse include physical injury and death, not to mention sexually transmitted disease, and psychological damage. According to an article published in 2002 in the “American Journal of Preventive Medicine,” long-term conditions associated with IPV also include chronic pain, migraine headaches, and neurologic disorders.

For this reason, the Institute of Medicine recommends that screening for IPV should be undertaken on a routine basis by health care providers. Sensitive questioning in a supportive setting could go a long way to identify women at risk and allow for interventions that reduce violence and improve the physical and psychological future of the victims of IPV.

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A number of studies have evaluated the diagnostic accuracy of IPV screening instruments, and one-third of them were found to demonstrate significant accuracy in identifying women with current or recent IPV, according to a review published in the June 05 edition of “Annals of Internal Medicine.” In fact, positive responses on the Partner Violence Screen predicted verbal aggression and violence during the four months after the screening.

More importantly from the patient perspective, about the same percentage of the studies reviewed that evaluated interventions to reduce IPV did indeed reduce IPV, improve birth outcomes for pregnant victims, and limit pregnancy coercions.

Researchers continue to refine screening approaches, based on findings in a variety of clinical trials:

• Women are more likely to disclose IPV using self-administered questionnaires (as opposed to face-to-face encounters).

• Computerized screening increases rates of IPV disclosure and acceptance of interventions.

• Patients prefer audio questionnaires for their privacy and avoidance of “memorializing” written descriptions that could be interpreted as putting them at further risk.

No matter what IPV-seeking instrument works best in identifying and helping the victims of IPV, the greatest asset in the health care profession in preventing further damage from IPV has its foundation in the sensitivity of the doctors, nurses, medical assistants and receptionists who are the ones to most likely have first contact with the IPV victim. If we lack sensitivity, we have indeed “lost the patient”—figuratively, and possibly literally.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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