Chronic patients with an abuse history can successfully complete a rehabilitation programme if the programme is designed to treat their psychosocial distress. Moreover, this also carries over to treatment outcome. A history of abuse does not have to negatively impact long-term treatment outcomes in this population of chronic pain patients.

Fibromyalgia is a chronic condition that is diagnosed primarily by the presence of generalized pain along with tenderness on palpation of certain body regions. Unfortunately, the pharmacological treatment of fibromyalgia remains problematic. Two patients are described who highlight the use of the atypical neuroleptic olanzapine for the control of symptoms related to fibromyalgia. Prior to the use of olanzapine, both patients had received a multitude of treatments, none of which greatly improved their ability to function in daily activities. With olanzapine, both patients reported a significant decrease in pain and marked improvement in daily functioning. In one case, the pain returned during a period of time when olanzapine was discontinued, an effect that was reversed when olanzapine was reintroduced. The paucity of serious side effects (i.e., extrapyramidal signs) with the atypical neuroleptic olanzapine strongly favors further exploration and use of this drug for the treatment of fibromyalgia symptoms.

Selected Thematic Apperception Test (Murray, 1943) stories of 39 physically abused children and a clinical group of 39 children with no recorded history of abuse were examined using the Social Cognition and Object Relations Scales (Westen, Lohr, Silk, Kerber, & Goodrich, 1985). As predicted, a history of physical abuse was associated with a more malevolent object world; a lower level capacity for emotional investment in relations and moral standards; and less accurate, complex, and logical attributions of causality in understanding human interaction. These impairments in object relations were manifest both as a typical level of functioning and as a propensity for more grossly pathological functioning. Results are discussed in terms of clinical and theoretical implications.

Fibromyalgia is a significant clinical problem associated with generalized pain and significant interference with daily activities. Although a variety of treatment modalities have been utilized, clinicians have struggled to find an effective means of treatment. Therefore, this study assessed the efficacy of the atypical neuroleptic olanzapine for the treatment of fibromyalgia symptoms. To examine the efficacy of olanzapine for the treatment of fibromyalgia symptoms, the charts of 51 patients treated with olanzapine were evaluated for improvements in pain and daily life functioning. At the time of initial assessment, patients had been diagnosed with a variety of medical and psychiatric disorders and a history of neuroleptic treatment. Pain was widespread and characteristic of pain associated with fibromyalgia. Pretreatment ratings on pain and the interference scales averaged 6.54-8.69 on a 0-10 scale. Post-treatment ratings on the same scales revealed significant improvement on virtually all scales. The benefits of olanzapine to improve fibromyalgia symptoms must, however, be carefully considered because there were a variety of side effects (i.e., weight gain, somnolence/sedation) that were of sufficient strength to cause a number of patients to discontinue treatment. In general, the data provide strong support that olanzapine can, in certain patients, improve symptoms associated with fibromyalgia in patients who have had limited success with other treatment modalities.

TAT stories of 17 sexually abused female subjects and a clinical group of 25 female subjects with no documented history of sexual abuse were analyzed using the Object Relations and Social Cognition Scoring System (Western, Lohr, Silk, Kerber, & Goodrich, 1985). Subjects ranged in age from 5 to 16 years. As predicted, mean scores on a measure of overall object relations were significantly different between groups. Specifically, the mental representations of subjects in the abuse group were characterized by more primitive and simple characterizations of people, more negative and punitive affect in their perceptions of the interpersonal world, an inability to invest in people and relationships in other than need-gratifying ways, and an inability to make sensible attributions of self and others. Abuse subjects also produced more pathological responses overall than did their nonabuse counterparts, indicating a tendency toward more extreme and immature functioning. These group differences were independent of any contribution of age and a measure of verbal productivity. Treatment and diagnostic implications are discussed.