Exposure to domestic abuse in women and the development of syndromes indicating central nervous system sensitization, 2021, Chandan et al

The association between exposure to domestic abuse in women and the development of syndromes indicating central nervous system sensitization: A retrospective cohort study using UK primary care records

Abstract
Background
Domestic abuse is a global public health issue. The association between the development of central sensitivity syndromes (CSS) and previous exposure to domestic abuse has been poorly understood particularly within European populations.

Methods
A retrospective cohort study using the ‘The Health Improvement Network,’ (UK primary care medical records) between 1st January 1995–31st December 2018. 22,604 adult women exposed to domestic abuse were age matched to 44,671 unexposed women. The average age at cohort entry was 36 years and the median follow-up was 2.5 years. The outcomes of interest were the development of a variety of syndromes which demonstrate central nervous system sensitization. Fibromyalgia, chronic fatigue syndrome and temporomandibular joint disorder outcomes have been reported previously. Outcomes were adjusted for the presence of mental ill health.

Results
During the study period, women exposed to domestic abuse experienced an increased risk of developing chronic lower back pain (adjusted incidence rate ratio [aIRR] 2.28; 95% CI 1.85–2.80), chronic headaches (aIRR 3.15; 95% CI 1.07–9.23), irritable bowel syndrome (aIRR 1.41; 95% CI 1.25–1.60) and restless legs syndrome (aIRR 1.89; 95% CI 1.44–2.48). However, no positive association was seen with the development of interstitial cystitis (aIRR 0.52; 95% CI 0.14–1.93), vulvodynia (aIRR 0.42; 95% CI 0.14–1.25) and myofascial pain syndrome (aIRR 1.01; 95% CI 0.28–3.61).

Conclusion
This study demonstrates the need to consider a past history of domestic abuse in patients presenting with CSS; and also consider preventative approaches in mitigating the risk of developing CSS following exposure to domestic abuse.

Significance
Domestic abuse is a global public health issue, with a poorly understood relationship with the development of complex pain syndromes. Using a large UK primary care database, we were able to conduct the first global cohort study to explore this further. We found a strong pain morbidity burden associated with domestic abuse, suggesting the need for urgent public health intervention to not only prevent domestic abuse but also the associated negative pain consequences.

Open access full text
https://onlinelibrary.wiley.com/doi/10.1002/ejp.1750

 

I wonder how they'd interpret asking the same thing of, say, professional wrestlers, who pretty much bruise their bodies for a living. It's not as if physical violence involved... you know... physical violence. What they'd say about the psychosocial context of, I don't know, machismo or some junk like that? Professional athletes are pretty famous for this, because of the repeated physical injuries and strain.

Unless they mean to imply that physical violence is harmless other than the immediate harm? Including violence ongoing for years. Because it really sounds like a necessary assumption to this weird construct happening here.

Then again this is more or less the basis behind psychosocial beliefs about whiplash and TBI not possibly being able to account for the resulting illness, completely removing the context in which it happened simply because it's necessary for the ideologically-driven conclusion.

 

A really high number of women who've experienced intimate partner violence have some kind of traumatic brain injury. For many this goes undiagnosed. I wonder if they screened for this in the study.

I agree with @rvallee. The line, 'consider preventative approaches in mitigating the risk of developing CSS following exposure to domestic abuse' seems to suggest that they think these women's symptoms are caused by a process which begins after the violence and which they could prevent from happening, as opposed to being a direct result of the violence itself.

 

@rvallee @Tia re potential for brain injury with repetitive trauma

The retrospective study below about the increased risk of neurodegenerative disease in professional Scottish footballers (soccer)came out a few months ago. The risk was lowest for goalkeepers, and increased for those in positions where they were more likely to 'head' the ball (defenders at highest risk), and also with length of career. It generated considerable media interest here and debate heading the ball.

https://www.theguardian.com/footbal...lth-warning-dementia-expert-dr-willie-stewart

https://www.gla.ac.uk/news/headline_803997_en.html

Full paper open access:

https://jamanetwork.com/journals/jamaneurology/fullarticle/2782750

 

Yeah @Tia & @rvallee care not taken for the damage done to athletes bodies with catastrophic consequences to their health. The connection between injury acquired through their sports and longer term conditions and complications are also minimised and denied, for as long as possible again as a way to avoid Financial liability for those who have benefited financially without risk to their own physical bodies.


Despite the overlap with all those experiencing pain and disease following a history of repeated injury, the way in which these negative outcomes are discussed in relation to the individuals who sustain this damage to their bodies, is very different.

Depending on the circumstances under which the original injuries are sustained the degree of judgment against the suffers fundamental being will differ enormously.