Hi. This next part is about abuse, conflict and social stressors as it relates to chronic pain. The prevalence of rape and physical assault in a lifetime is surprisingly high. Now this survey done in 1995 looked at the prevalence of total rape or physical assault among 8,000 men and 8,000 women. And you could see that the frequency of rape among women was 17.6% and 3.0% among men. The total percentage of, or prevalence of physical assault was 51.9% among women. And 66.4% among men. And you can see there is a variety of different types of definition of assault. From being slapped or hit, kicked or bit, choked, beat up etc. All of these things create a significant trauma in a person's life. And even developed PTSD in some situations. But as importantly with regard to this course, it will lead to chronic pain. So, two large-scale national surveys in the U.S. found that pain is five times more common among people of any age who report a previous history of abuse or violence. Either in a domestic or a public setting. And the same thing is true of rape and chronic pain. Rape and sexual assault has been estimated to occur in, in 18% of all women in the US. And it's strongly associated with many pain conditions, including vaginal pain and inflammation, painful sexual intercourse, pelvic pain, headaches and orofacial pain as well as depression and suicidal ideation. And it's not just about assault or abuse of adults but childhood abuse is also very common. The history of childhood physical abuse is, ranges in different studies from 10% to 31% in men and 6% to 40% in women in different studies. Whereas the history of childhood sexual abuse is 3% to 29% in men, 7% to 36% in women in different studies. The consequences of childhood abuse is very, very profound. There's significant amount of chronic pain, headaches, orofacial pain, pelvic pain, fibromyalgia, and many other pain conditions as adults. It also leads to depression, anxiety, eating disorders, post-traumatic stress disorders, chronic fatigue, and irritable bowel. It's a significant problem, and it's not just about physical abuse. It's also about verbal abuse. Verbal abuse hurts, too. And as this slide shows, sticks and stones may break my bones, but words can break your soul. So, verbal abuse is, is common in our society. And some, many grown men and women feel they need to gain power over others by yelling at them, calling them useless and worthless. And screaming until the other person obeys. Although no physical harm occurs directly, but the effects can be as bad. Patients who are constantly verbally abused develop chronic pain, migraine, daily headaches, stammering, ulcers, spastic colon, indigestion, diarrhea, constipation and heart conditions. And they develop a lot of psychological issues too such as fear, anxiety, depression and stress, PTSD, intrusive memories, memory gaps, sleep or eating problems, hyper-vigilance and exaggerated startle response, they're always just waiting for someone to yell at them. Irritability, anger issues. Often involved in alcohol or drug abuse. And sometimes suicidal tendencies, or suicide, self mutilization, and assaultive behaviors. All of which are a consequence of persistent verbal abuse. But the question comes up, why do people hurt others? Well, it is a complex issue. And it's something that nobody really has an answer to, but the research is evolving and there are many risk factors that can lead to becoming an abusive person. And one is a big factor is of course the history of childhood abuse and the defensive fear of getting hurt even more. But, but there's other factors too such as low empathy, empathy for others, coupled with low self esteem. Borderline personalities have been found to be characteristic of abusers. Alcoholism and drug abuse are very common. There's even studies on genetic links between impulsivity and sensation seeking behavior among abusers or those who have a tendency for violence. Revenge and spite to show others what the pain and anguish they feel may be a factor, showing power and control over others, depression, anger chronic pain traumatic and repeated head injuries. And interestingly enough, higher levels of toxic heavy metals have been found in some people who are prone to violence, mang, mag, manganese, lead, cadmium, and copper. So, it's still unexplained to some extent, but there are risk factors that can play a role and we need to be aware of those. And there are things that we can do to help prevent abuse, rape, and assault and create more of a personal safety. So, prevention is really the key to personal safety. ,here are some suggestions, examples that I found in the literature that have helped but there's many more that can be done. and, and should be knowledgeable about. Getting help is really the best way to end an abusive relationships. Do not lose control through excessive alcohol or drugs. Do not walk alone, particularly at night. Check if there have been any assaults in a location or by a certain house that you frequent. Crime statistics will suggest an area or time that is higher risk, and ensure mobile phone has coverage in all areas, and look for suspicious people. Call if someone is following you. Do not let strangers into your home or get into their car. So, these are some of the very few, but suggestions on what you can do, to prevent, this type of trauma. Now, there's also a new type of abuse that occurs out there, and that's Internet abuse. This is an inability, a person's inability to control use of the Internet, and it leads to many problems. Sleep deprivation, sustained sitting posture and inactivity, carpal tunnel, jaw, neck, and back pain, disrupted family relationships, academic problems, depression, anxiety, compulsivity, fear that life without the Internet would be boring, empty, and joyless, and loneliness and social isolation. And there's a tendency to imitate behaviors and values of online characters, which will include also being a bully. Or some type of abuse. So, these people are prone to be a cyber bully or even a victim of one. So, we need to be cautious about this possibility also. So. The take home, with regard to this part, is to really focus on understanding the concepts of negative neuroplasticity, PTSD, chronic pain can result from abuse and trauma. Prevalence of lifetime sexual abuse is at 18% while assault is over 15% of the population. We need to work on preventing and reducing these factors. Verbal abuse and Internet abuse can also have a negative impact as, as much as physical abuse and reasons why people hurt other people are still unclear. We need to do more research in that area. And taking personal safety measures to prevent abuse, rape, and assault is critical. And, and be aware of the people around you who may be abusers. Thank you. [BLANK_AUDIO]
