Scarinci I C, McDonald-Haile J, Bradley L A, Richter J E
Division of Gastroenterology, University of Alabama at Birmingham 85294.
Am J Med. 1994 Aug;97(2):108-18. doi: 10.1016/0002-9343(94)90020-5.
To evaluate the relationships between sexual/physical abuse, pain perception, environmental events, coping strategies, and psychiatric morbidity in a sample of female patients with painful gastrointestinal disorders.
Fifty paid volunteers from a tertiary care center including 13 patients with gastroesophageal reflux disease (GERD), 26 with noncardiac chest pain (NCCP), and 11 with irritable bowel syndrome (IBS).
(1) Sexual and physical abuse interview questions; (2) Structured psychiatric interview; (3) Self-report questionnaires: demographics, clinical pain measurement, Millon Behavioral Health Inventory, Hassles and Uplifts Scales, Sickness Impact Profile, Life Experiences Survey, Pain Beliefs and Perceptions Inventory, and Coping Strategies Questionnaire; (4) Pain Perception and Sensory Decision Theory tasks.
Fifty-six percent of the sample reported a history of sexual/physical abuse. Abuse was significantly more prevalent among patients with GERD (92%) and IBS (82%) compared with those with NCCP (27%). Abused patients, relative to nonabused patients, had significantly lower pain threshold levels in response to finger pressure stimuli and significantly lower cognitive standards for judging stimuli as noxious. Abused patients reported significantly higher levels of functional disability and a significantly greater number of psychiatric disorders, minor daily hassles, and pain syndromes unrelated to gastrointestinal disorders. In addition, abused patients more frequently blamed themselves for their pain and reported significantly greater use of maladaptive pain coping strategies than nonabused patients.
These data suggest that the relationships between abuse, disability, multiple pain syndromes, and health care seeking behavior are mediated by abnormal pain perception, psychiatric disorders, disruption of physical function, and environmental stressors.
评估患有疼痛性胃肠疾病的女性患者样本中性虐待/身体虐待、疼痛感知、环境事件、应对策略和精神疾病之间的关系。
来自三级护理中心的50名付费志愿者，包括13名胃食管反流病（GERD）患者、26名非心源性胸痛（NCCP）患者和11名肠易激综合征（IBS）患者。
（1）性虐待和身体虐待访谈问题；（2）结构化精神访谈；（3）自我报告问卷：人口统计学、临床疼痛测量、米隆行为健康量表、烦恼与愉悦量表、疾病影响概况、生活经历调查、疼痛信念与感知量表以及应对策略问卷；（4）疼痛感知和感觉决策理论任务。
56%的样本报告有性虐待/身体虐待史。与NCCP患者（27%）相比，GERD患者（92%）和IBS患者（82%）中虐待情况明显更普遍。与未受虐待的患者相比，受虐待患者对手指压力刺激的疼痛阈值水平明显更低，将刺激判断为有害的认知标准也明显更低。受虐待患者报告的功能残疾水平明显更高，精神疾病、日常小烦恼和与胃肠疾病无关的疼痛综合征数量明显更多。此外，受虐待患者比未受虐待患者更频繁地将疼痛归咎于自己，并且报告使用适应不良疼痛应对策略的情况明显更多。
这些数据表明，虐待、残疾、多种疼痛综合征和寻求医疗行为之间的关系是由异常疼痛感知、精神疾病、身体功能紊乱和环境压力源介导的。
