Trauma History in Chronic Pain Syndromes
Caitlyn Desir, MD, Sanchita Bose, MD.
Maine Medical Center, Portland, ME, USA.
Background: Physical and emotional trauma is unfortunately a common occurrence in the United States and long term effects of trauma have been discussed extensively in the literature. The CDC alongside Kaiser Permanente conducted a study published in the American Journal of Preventive Medicine in 1998 known as “The Adverse Childhood Experiences Study” (ACE Study) that demonstrated what had long been suspected, that there is an association between adverse childhood experiences (ACEs) and health and social problems across a lifetime. A history of trauma has been more specifically linked to those with chronic pain syndromes, which often leads to extensive medical referrals to specialists and is often challenging to treat due to the poorly understood etiology of their symptoms and can be frustrating for both the provider and patient. Dr. Van Der Kolk writes in his book The Body Keeps the Score, that “children who have developed in the context of ongoing danger, maltreatment, and inadequate caregiving systems are ill-served by the current diagnostic system, as it frequently leads to no diagnosis, multiple unrelated diagnoses, an emphasis on behavioral control without recognition of interpersonal trauma and lack of safety in the etiology of symptoms, and a lack of attention to ameliorating the developmental disruptions that underlie the symptoms.” Chronic pain syndromes are commonly seen in our urology practice, and it is unclear how many of these patients have undergone appropriate screening and treatment for past trauma prior to being referred to us. We hypothesize that most patients will have not been asked about trauma history prior to being referred to a Urologist for their chronic pain.
Methods: We did a retrospective chart review of patients seen by 3 specific providers in our practice for chronic pelvic pain over the past 3 years. This included 80 patients. We excluded pediatric patients and any patients who were found to have a somatic explanation for their pain upon urologic evaluation such as cancer, UTI or nephrolithiasis. There were 47 patients remaining who were included in our study. The following data was collected: reason for urologic referral, a mental health diagnosis documented in their problem list (including anxiety, depression, PTSD) and mention of trauma history listed in their referral.
Results: Of the 47 patients, 82% were female, 26 had a medical diagnosis of PTSD, anxiety, or depression, 18 had significant trauma documented elsewhere in their medical chart (such as detailed mental health, trauma, abuse, or PTSD history). Only 9 patients had trauma history documented in urology referral.
Conclusion: Many patients with significant trauma are evaluated in our urology office for chronic pain without a trauma history ever being considered as part of the etiology of the pain. These patients subsequently undergo a urological evaluation and often leave the office without an explanation for their pain. We must consider trauma as a risk factor for patients with chronic pain in order to treat the patient in a more holistic fashion and assure they get the multidisciplinary care that they need.
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