THE RELATIONSHIP BETWEEN SOCIAL SUPPORT ACES AND CHRONIC

THE RELATIONSHIP BETWEEN SOCIAL SUPPORT, ACES, AND CHRONIC PAIN F. DAVID SCHNEIDER, MD JEFFREY SCHERRER, PHD TERRI WEAVER, PHD CARISSA VAN DEN BERK CLARK, PHD JOANNE SALAS, MPH UT SOUTHWESTERN AND SAINT LOUIS UNIVERSITY

Background Positive social relationships have a positive impact on health Promote healthy behaviors Better adherence to medical treatment Positive social networks can decrease perception of pain, improve function Little knowledge of how stressful relationships effect health High ACE scores associated with poor pain outcomes

What we studied Pilot study Examine the relationship between quality of social networks and health outcomes in patients with chronic pain Chronic pain because of the frequency and challenging nature of the issue Cross sectional study Long interview Structure and function of social networks Health status, pain level, physical functioning, role functioning, depression and anxiety, PTSD, and quality of life

Hypotheses Close stressful relationships and PTSD are both significant moderators of the relationship between child abuse and health outcomes in adults with chronic pain PTSD moderates the relationship between close stressful social relationships and health outcomes in adult survivors of child abuse with chronic pain

Social Networks Pilot study of 41 chronic pain patients in primary care Used Social Convoy Model to help patients identify 2 closest relationships and characteristics of those relationships Measured depression (PHQ-9), anxiety (BAI-PC), PTSD (PDS and trauma screen)

Sample n % Age, mean 41 52. 8 (12. 7) Female gender, % 25 61. 0 Race, % African American White Other 16 20 5 39. 0 48. 8 12. 2 Married, % 17 41. 5 College Degree, % 10 24. 4 Over 50, 000 K Household Income, % 4 9. 8 Employed full time, % 7 17. 1 Privately insured, % 11 26. 8

Sample - Health n % Anxiety, % 21 51. 2 Arthritis, % 27 65. 8 Back pain, % 27 65. 8 Depression, % 26 63. 4 Diabetes, % 9 21. 9 Heart Disease, % 4 9. 8 Hypertension, % 20 48. 8 Joint Pain, % 31 75. 6 Obesity, % 16 39. 0 Stomach Problems, % 11 26. 8 Current Smokers, % 10 24. 4 Binge Drinking past 30 days, % 10 24. 4

Association of social network variables with pain and mental health variables, stratified by number of ACES <4 (n=26) Positive social network ACES≥ 4 (n=15) Negative social network Social network balance Positive social network 0. 04 0. 44 -0. 23 -0. 01 0. 04 -0. 07 Distress Level -0. 07 0. 51 -0. 33 -0. 14 0. 64 -0. 46 PDS total -0. 40 0. 36 -0. 44 0. 04 -0. 09 0. 10 PHQ-9 total -0. 16 0. 26 -0. 25 -0. 28 0. 52 -0. 36 0. 34 -0. 19 0. 18 0. 43 -0. 09 Pain Level BAI-PC total 0. 003 Negative social network Social network balance

Takaway 41 subjects Negative social networks were significantly and positively correlated with: Higher pain (r=0. 30) Greater pain-related distress (r=0. 54) Positive social networks were inversely correlated with: Pain severity (r=-0. 40) Negative social relationships among those with ACES=>4 more highly effects distress and depression levels

ACEs and Pain ACE scores of =>4 correlated in patients with negative social networks associated with more distress from pain (r=0. 64) However, these same people did not have more severe pain (r=. 04)

Conclusions Greater pain distress, but not pain severity suggests patients with high ACE scores have more difficulty coping Helping patients decrease their exposure to negative social relationships may mediate the effects of histories of toxic stress