Original Report| Volume 13, ISSUE 8, P736-741, August 2012

Acute Severe Pain Is a Common Consequence of Sexual Assault


      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%]) 1 week later. Pain in 4 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 1 week follow-up. Among survivors with severe pain at the time of initial postassault 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 postassault period, but rarely treated.


      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.

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        • Bijur P.E.
        • Latimer C.T.
        • Gallagher E.J.
        Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department.
        Acad Emerg Med. 2003; 10: 390-392
        • Black M.C.
        • Basile K.C.
        • Breiding M.J.
        • Smith S.G.
        • Walters M.L.
        • Merrick M.T.
        • Chen J.
        • Stevens M.R.
        The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report.
        National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA2011
        • Brooks R.
        • Silove D.
        • Bryant R.
        • O’Donnell M.
        • Creamer M.
        • McFarlane A.
        A confirmatory factor analysis of the acute stress disorder interview.
        J Trauma Stress. 2008; 21: 352-355
        • Carroll L.J.
        • Holm L.W.
        • Hogg-Johnson S.
        • Cote P.
        • Cassidy J.D.
        • Haldeman S.
        • Nordin M.
        • Hurwitz E.L.
        • Carragee E.J.
        • van der Velde G.
        • Peloso P.M.
        • Guzman J.
        Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): Results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.
        Spine. 2008; 33: S83-S92
        • Gamaro G.D.
        • Xavier M.H.
        • Denardin J.D.
        • Pilger J.A.
        • Ely D.R.
        • Ferreira M.B.
        • Dalmaz C.
        The effects of acute and repeated restraint stress on the nociceptive response in rats.
        Physiol Behav. 1998; 63: 693-697
        • Green P.G.
        • Alvarez P.
        • Gear R.W.
        • Mendoza D.
        • Levine J.D.
        Further validation of a model of fibromyalgia syndrome in the rat.
        J Pain. 2011; 12: 811-818
        • Hoge E.
        • Worthington J.
        • Nagurney J.
        • Chang Y.
        • Kay E.
        • Feterowski C.
        • Katzman A.
        • Goetz J.
        • Rosasco M.
        • Lasko N.
        • Zusman R.
        • Pollack M.
        • Orr S.
        • Pitman R.
        Effect of acute posttrauma propranolol on PTSD outcome an physiological responses during script-driven imagery.
        CNS Neurosci Ther. 2012; 18: 21-27
        • Holbrook T.L.
        • Galarneau M.R.
        • Dye J.L.
        • Quinn K.
        • Dougherty A.L.
        Morphine use after combat injury in Iraq and post-traumatic stress disorder.
        N Engl J Med. 2010; 362: 110-117
        • Imbe H.
        • Iwai-Liao Y.
        • Senba E.
        Stress-induced hyperalgesia: Animal models and putative mechanisms.
        Front Biosci. 2006; 11: 2179-2192
        • Kilpatrick D.
        • Edmunds C.
        • Seymour A.
        Rape in America: A Report to the Nation.
        National Victim Center, Arlington, VA1992
        • Krebs E.E.
        • Carey T.S.
        • Weinberger M.
        Accuracy of the pain numeric rating scale as a screening test in primary care.
        J Gen Intern Med. 2007; 22: 1453-1458
        • Macintyre P.E.
        • Schug S.A.
        • Scott D.A.
        • Visser E.J.
        • Walker S.M.
        APM:SE Working Group of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine: Acute Pain Management.
        Scientific Evidence, Melbourne, AU2010
        • McLean S.A.
        • Diatchenko L.
        • Lee Y.M.
        • Swor R.A.
        • Domeier R.M.
        • Jones J.S.
        • Jones C.W.
        • Reed C.
        • Harris R.E.
        • Maixner W.
        • Clauw D.J.
        • Liberzon I.
        Catechol O-methyltransferase haplotype predicts immediate musculoskeletal neck pain and psychological symptoms after motor vehicle collision.
        J Pain. 2011; 12: 101-107
        • Orrey D.C.
        • Bortsov A.V.
        • Hoskins J.M.
        • Shupp J.W.
        • Jones S.W.
        • Cicuto B.J.
        • Hwang J.
        • Jordan M.H.
        • Holmes J.H.
        • Haith L.R.
        • Roane B.M.
        • Diatchenko L.
        • Cairns B.A.
        • McLean S.A.
        Catechol-O-Methyltransferase Genotype Predicts Pain Severity in Hospitalized Burn Patients.
        J Burn Care Res. 2012 Jan 2; ([Epub ahead of print])
        • Roy-Byrne P.
        • Russo J.
        • Mcihelson E.
        • Zatzick D.
        • Pitman R.
        • Berliner L.
        Risk factors and outcome in ambulatory assault victims presenting to the acute emergency department setting: Implications for secondary prevention studies in PTSD.
        Depress Anxiety. 2004; 19: 77-84
        • Satoh M.
        • Kuraishi Y.
        • Kawamura M.
        Effects of intrathecal antibodies to substance P, calcitonin gene-related peptide and galanin on repeated cold stress-induced hyperalgesia: Comparison with carrageenan-induced hyperalgesia.
        Pain. 1992; 49: 273-278
        • Shalev A.Y.
        • Freedman S.
        • Peri T.
        • Brandes D.
        • Sahar T.
        • Orr S.P.
        • Pitman R.K.
        Prospective study of posttraumatic stress disorder and depression following trauma.
        Am J Psychiatry. 1998; 155: 630-637
      1. Soward A, Orrey D, Rotolo S, Rossi C, Roane B, Csontos E, Casto T, Wheeler B, Rauch S, Slade G, McLean SA: Incidence and distribution of pain symptoms after sexual assault [abstract]. Presented at the Annual Scientific Meeting of the American Pain Society, Baltimore, MD, May 6-8, 2010

        • Summer G.J.
        • Puntillo K.A.
        • Miaskowski C.
        • Green P.G.
        • Levine J.D.
        Burn injury pain: The continuing challenge.
        J Pain. 2007; 8: 533-548
      2. The National Hospital Ambulatory Medical Care Survey (NHAMCS). Accessed November, 2011

        • Tjaden P.
        • Thoennes N.
        Full report of prevalence, incidence, and consequences of violence against women: Findings from the National Violence Against Women Survey (NCJ 183781).
        National Institute of Justice, Washington, DC2000
        • Vidal C.
        • Jacob J.
        Hyperalgesia induced by non-noxious stress in the rat.
        Neurosci Lett. 1982; 32: 75-80
      3. Westphal W, Soward AC, Rossi C, Rotolo S, Heafner T, Foley K, Batts J, Casto T, Collette R, Holbrook D, Goodman E, Harney K, Csontos E, Rauch S, Liberzon I, McLean SA: Severe pain is common but rarely treated in the immediate aftermath of sexual assault [abstract]. Presented at the Annual Scientific Meeting of the American Pain Society, Austin, TX, May 19-21, 2011

      Linked Article

      • The Need to Focus on Pain Management Among Sexual Assault Survivors
        The Journal of PainVol. 14Issue 3
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          The recently published paper by McLean et al is important. It highlights that pain is common in sexual assault (SA) survivors but rarely treated. The authors state that treatment of pain is necessary, not only to decrease suffering but also to reduce negative psychological outcomes. The article substantiates that 64% of SA survivors at the time of Sexual Assault Nurse Examiner (SANE) evaluation are in severe pain, while only 13% receive pain medication. Furthermore, 1 week later, 52% of the victims remain in severe pain.
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