Despite the fact that the majority of women presenting to EDs for care after sexual assault experience severe pain, very few receive pain treatment, according to a study.
“To our knowledge, this is the first prospective study of pain symptoms in the early aftermath of sexual assault,” Samuel McLean, MD, MPH, the studys lead investigator and the director of the TRYUMPH Research Program in the Department of Anesthesiology at the University of North Carolina School of Medicine, said in a news release.
Women who receive medical care after sexual assault are often treated by sexual assault nurse examiners and emergency physicians. SANEs have completed training in the delivery of care to sexual assault survivors, including both forensic evidence collection and medical treatment.
Researchers evaluated the severity and distribution of pain symptoms and the treatment of pain in 83 women who presented for care within 48 hours of being sexually assaulted. These women sought care at one of 10 EDs/SANE programs located in diverse environments ranging from inner-city Baltimore to rural Appalachia.
Of the women in the study, 64% reported severe pain (pain rated as 7 or greater on a 10-point numeric scale) at the time of initial evaluation and 52% reported severe pain one week later.
Among women reporting severe pain at the time of initial evaluation, only 13% received any pain medication.
Also, 53% reported pain in four or more body regions at the time of initial evaluation and 59% reported pain in four or more body regions one week later. Most often, areas with pain were not areas that were directly injured during the assault.
For example, one woman was vaginally raped with her 6-week-old baby in her arms. She reported no physical trauma and stated that she offered no resistance because of concerns for her childs safety. At the time of initial SANE evaluation, she reported pain in seven extragenital regions, and her maximal pain intensity score was a 10. One week later, she reported continued pain in three areas and a continued pain score of 10.
“Information from our study, together with other emerging data from the pain research field, suggest that pain in the aftermath of stressful events such as sexual assault may not simply be an ancillary experience resulting from co-occurring physical trauma,” McLean said. “Rather, like psychological symptoms, pain symptoms after sexual assault may be a neurobiological consequence of the stress experience itself.”
The research team said pain evaluation and treatment should be part of the standard care of sexual assault survivors, not only to reduce immediate suffering but also because evidence suggests that the treatment of acute pain may improve long-term outcomes. “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,” they wrote.
This research was supported by a grant from the NIH Clinical and Translational Science Awards program at UNC. The study appeared June 15 on the website of the Journal of Pain. To read the abstract and access the study via subscription or purchase, visit http://bit.ly/MsQ2g6.