In ordinal logistic regression models, adjusted for demographic variables and current depression and anxiety, emotional abuse (OR = 1.69, 95% CI: 1.22-2.33, P = .0013) and physical neglect (OR = 1.73, 95% CI: 1.22-2.46, P = .0018) were independently associated with a higher number of pain conditions. Similarly in the model restricted to women, emotional abuse (OR = 1.94, 95% CI: 1.39-2.71, P = .0002) and physical neglect (OR = 1.893, 95% CI: 1.34-2.68, P = .0006) were independently associated with higher number of comorbid pain conditions. There was a weak but significant direct positive correlation Selleck BEZ235 (r = 0.22, P < .001) between the number of maltreatment types and the number

of pain conditions. We had reported in Part II that emotional and physical abuse were associated MG-132 clinical trial with frequency >15 days per month and with transformation from episodic to chronic migraine.

In this analysis, we found that those participants who reported ≥4 pain comorbidities were more likely to be diagnosed transformed migraine as compared with those who had 3 or fewer comorbidities (χ2 = 4.64, P = .03). As compared with those participants who had no comorbidities, the participants with pain conditions were significantly more likely to be diagnosed with chronic headaches (P = .003, χ2 = 9.060) and were significantly more likely to be diagnosed with continuous daily headaches (P < .001, χ2 = 26.21). In this study on childhood maltreatment and adult pain, there are several novel findings. In specialty clinic patients with ICHD-2 criteria-based, physician-diagnosed

migraine, both comorbid pain conditions and childhood maltreatment second history were common, reported by over half of those surveyed. Migraineurs reporting childhood emotional abuse or physical neglect had significantly higher number of comorbid pain conditions compared with those without a history of maltreatment. The associations of maltreatment and pain were independent of depression and anxiety, both of which are highly prevalent in this population. Our findings of an abuse–pain relationship are in keeping with those from a number of studies similarly based on retrospective interviews with patients in specialty pain practices.27 The possibility of selection-bias in clinic-based studies is well recognized, but several population-based samples have also found abuse–pain associations. A community sample of 3381 women, for example, found that chronic pain was significantly associated with physical but not sexual abuse.28 A second smaller (n = 649) community-based study in men and women found a relationship between self-reports of abuse and adult pain conditions, but for sexual and not physical abuse.29 In a study of sexual abuse using a random sample of students (486 men and 510 women) in Norway it was found that severity of abuse was linearly associated with pain complaints, including genital, abdominal, muscular, and head pain.