Acute Severe Pain Is a Common Consequence of Sexual Assault

Abstract

Sexual assault (SA) is common, but the epidemiology of acute pain after SA has not previously been reported. We evaluated the severity and distribution of pain symptoms in the early aftermath of SA among women receiving sexual assault nurse examiner (SANE) care, and the treatment of pain by SANE nurses. Severe pain (≥7 on a 0–10 numeric rating scale) was reported by 53/83 women sexual assault survivors (64% [95% CI, 53%–74%]) at the time of SANE evaluation and 43/83 women (52% [95% CI, 41%–63%]) one week later. Pain in four or more body regions was reported by 44/83 women (53% [95% CI, 42%–64%]) at the time of initial evaluation and 49/83 women (59% [95% CI, 48%–70%]) at one week follow-up. Among survivors with severe pain at the time of initial post-assault evaluation, only 7/53 (13% [95% CI, 6%–26%]) received any pain medication at the time of initial SANE treatment. These findings suggest that pain is common in SA survivors in the early post-assault period, but rarely treated. Perspective Acute pain is common after sexual assault. Practice guidelines for SANE nurses and others who provide care to sexual assault survivors in the early aftermath of assault should include specific recommendations for pain evaluation and treatment. Prospective longitudinal studies of pain outcomes among sexual assault survivors are needed.

Chronic widespread pain after motor vehicle collision typically occurs through immediate development and nonrecovery

“…Findings of the present study supporting a non-recovery model of CWP development are consistent with increasing evidence that pain outcomes after stress exposures such as MVC are mediated by central neurobiological mechanisms [2; 6; 8; 30; 32; 33; 43; 44]. This evidence includes data that pain in the immediate aftermath of other stressful events such as sexual assault is located in many body regions, most of which experienced no tissue trauma, and that the distribution of body regions with pain continues to expand in the initial week after stress exposure[33].…”

“…This evidence includes data that pain in the immediate aftermath of other stressful events such as sexual assault is located in many body regions, most of which experienced no tissue trauma, and that the distribution of body regions with pain continues to expand in the initial week after stress exposure[33]. These data are consistent with evidence that stress exposure can result in widespread changes in sensory processing due to mechanisms such as the sensitization of peripheral afferents by persistently elevated levels of catecholamines and glucocorticoids[24] and by endogenous opioid-induced hyperalgesia[2; 26].…”

μ-Opioid Receptor Gene A118G Polymorphism Predicts Pain Recovery After Sexual Assault

“…11,16,17,20,26,27,31,39,42 In a recent prospective study (n = 83), we reported that more than half of SA survivors experience severe pain in 4 or more body regions during the week after sexual assault. 32 Among women conscious throughout the assault, the majority of body areas of pain were not areas in which trauma was reported. 32 These data, together with individual case histories from women who reported no physical trauma but developed severe pain across multiple body regions, 32 suggest that stress-induced hyperalgesia may play an important role in development of pain after sexual assault.…”

“…32 Among women conscious throughout the assault, the majority of body areas of pain were not areas in which trauma was reported. 32 These data, together with individual case histories from women who reported no physical trauma but developed severe pain across multiple body regions, 32 suggest that stress-induced hyperalgesia may play an important role in development of pain after sexual assault.…”

Genetic variant rs3750625 in the 3′UTR of ADRA2A affects stress-dependent acute pain severity after trauma and alters a microRNA-34a regulatory site

“…[4; 38] In brief, women 18 years of age or older who presented to one of ten Sexual Assault Nurse Examiner (SANE) programs in four states for medical care within 72 hours of sexual assault were recruited. Women unable to give informed consent (e.g., due to intoxication) were excluded, as were women who were hospitalized after sexual assault, lived with their assailant, were prisoners, were pregnant, did not have a telephone, and/or did not live within driving distance for follow-up interviews.…”