Alice Goodman

May 13, 2013

New Orleans, Louisiana — Many women who experience pain due to sexual assault are not receiving medical care, mental health care, or pain medications in the first 6 weeks after being sexually violated, according to a pilot study designed to assess health-seeking behaviors of this subset of women.

"We know sexual assault is common, experienced by 1 in 5 women over a lifetime. About two thirds of these women report that they have associated pain. Our study shows that survivors develop persistent pain and that it is not being treated," said Samuel A. McLean, MD, MPH, an emergency physician at the University of North Carolina (UNC) School of Medicine in Chapel Hill.

He points out that Sexual Assault Nurse Examiner (SANE) practice guidelines should include specific recommendations for pain evaluation and treatment. "We have got to do better."

The study, presented here at the American Pain Society (APS) 32nd Annual Scientific Meeting, was a pilot effort to assess barriers to receiving adequate care after sexual assault and to identify strategies to funnel women who come to the ED for this reason to appropriate medical care.

The researchers recruited 84 patients who presented to 1 of 10 EDs at 10 different centers and received SANE care; 75 agreed to be interviewed at 1 week and 6 weeks after presenting to the ED.

During these interviews, pain was assessed by a scale of 0 to 10. A score of 4 or greater was deemed new pain, a score of 4 to 7 indicated moderate pain, and a score of 8 to 10 represented extreme pain.

For the analysis, 33 patients with new moderate or severe pain (NMSP) in 1 or more body region were grouped together, and results of their interviews were compared with those from 42 patients with no NMSP.

Although women with NMSP were more likely to seek medical care during the first 6 weeks after assault than those without NMSP, less than 50% of women accessed medical services.

Table. 6-Week Results

Measure Women With NMSP (%) Women Without NMSP (%)
Consulted primary care provider 48 24
Saw mental health provider 45 31
Received follow-up testing 42 33

Medication use of any type was low across the board, ranging from 3% to 5%, Dr. McLean noted.

In an interview with Medscape Medical News, Tim Platts-Mills, MD, an emergency physician at UNC Chapel Hill who was not involved in this study, said that these findings are important for 2 reasons.

"This is a vulnerable population; in fact, it's hard to imagine a more vulnerable population. Survivors of sexual assault have a hard time advocating for themselves and seeking care, whether due to shame or privacy needs," Dr. Platts-Mills said.

He finds the results concerning but not surprising. "These women have pain but are not getting cared for. Because these women did not have a clear injury pattern where a lot of tissue was affected, as in a car crash, the results suggest that the psychological stress of the assault may be a mechanism contributing to new persistent pain."

Dr. McLean's study was funded by a grant from the National Center for Research Resources at the National Institutes of Health. Dr. Platts-Mills has disclosed no relevant financial relationships but disclosed that he has collaborated with Dr. McLean on research in other patient populations.

American Pain Society (APS) 32nd Annual Scientific Meeting. Abstract 227. Presented May 9, 2013.


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