Chronic pain in women survivors of intimate partner violence.

UNLABELLED: In this descriptive study of chronic pain in a community sample of 292 women who had separated from their abusive partners on average 20 months previously, more than one-third experienced high disability pain as measured by Von Korff's Chronic Pain Grade. Beyond the usual pain locations associated with abuse, 43.2% reported swollen/painful joints. More interference in daily life was attributed to joint pain than to back, head, stomach, pelvic or bowel pain. Women with high disability pain were more likely to have experienced child abuse, adult sexual assault, more severe spousal abuse, lifetime abuse-related injuries, symptoms of depression and post-traumatic stress disorder, lifetime suicide attempts, difficulty sleeping, and unemployment. High disability pain also was associated with visits to a family doctor and psychiatrist and use of medication in more than prescribed dosages. Less than 25% of women with high disability pain were taking opioids, or prescription nonsteroidal anti-inflammatory medications. Interestingly, high disability pain was not related to smoking, use of street drugs, potential for alcohol dependence, age, income, or education. The findings add to knowledge of severity and patterns of chronic pain in abused women and support the need for further multivariate analysis of the relationships among abuse experiences, mental health, and chronic pain severity to better inform decisions regarding diagnosis and treatment. PERSPECTIVE: Understanding patterns of chronic pain in abuse survivors and their associations with abuse history, mental health symptoms, health service use, and medication is important for clinical assessment and intervention. Chronic pain persisted long after leaving abusive partners and extended beyond usual locations (back, headache, pelvic, gastrointestinal) to include swollen/painful joints.

Using grounded theory to generate a theoretical understanding of the effects of child custody policy on women's health promotion in the context of intimate partner violence.

Women's health is frequently influenced by social and structural factors, largely beyond women's control, and often entrenched in public policy. Although health is acknowledged to be socially determined, the ways that social conditions affect health are rarely explicated. Grounded theory is a useful method for discovering how structural conditions influence patterns of behavior. We used grounded theory to generate a theoretical understanding of how justice system policy and services related to child custody influence health promotion processes of women and their children after leaving abusive male partners/fathers. In two diverse Canadian provinces, we interviewed single mothers who had left abusive partners as well as frontline workers and policymakers in the justice system. We identified the key dimensions of policy and services that influence the ways in which women and their children promote their health in the context of varying levels of ongoing intrusion as information, eligibility, accessibility, timeliness, human resources, safety, and diversity. In this article, the interplay between theses policy and service dimensions and women's health promotion after leaving abusive partners is discussed and suggestions are made for strengthening "healthy" custody policy.