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Chronic pain and violent ideation: testing a model of patient violence

Daniel Bruns1, John M Disorbio, Richard Hanks

  • 1Health Psychology Associates, Greeley, CO 80634, USA. daniel.bruns@healthpsych.com

Pain Medicine (Malden, Mass.)
|March 21, 2007
PubMed
Abstract

Insights

Physicians face patient violence risk. A validated model shows pain patients with physical difficulties and psychosocial issues like hostility and dependency are at higher risk for violent ideation.

Area of Science:

  • Medical Research
  • Psychology
  • Public Health

Background:

  • Physicians are vulnerable to patient-perpetrated violence.
  • A clinical model for predicting patient violence was previously developed by Fishbain and colleagues.
  • This model hypothesized an increased risk of violence among pain patients.

Purpose of the Study:

  • To empirically test the Fishbain Model of patient violence risk.
  • To identify specific patient factors associated with increased risk of violence in pain patients.

Main Methods:

  • The study utilized multivariate analysis of variance (MANOVA) and chi-square procedures to test hypotheses derived from the Fishbain Model.
  • Data were collected from 527 adult patients (18-65 years) treated for injury and nonmalignant pain across 90 medical facilities in 30 U.S. states.
  • The sample demographics approximated U.S. Census data, ensuring representativeness.

Main Results:

  • Violent ideation in pain patients correlated significantly with physical difficulties, including pain (P=0.01), functional problems (P=0.0003), and somatic complaints (P=0.0001).
  • Significant psychosocial predictors of violent ideation included hostility (P<0.0001), dependency (P<0.0001), substance abuse (P<0.0001), litigation (P<0.001), and distrust of the physician (P<0.001).

Conclusions:

  • The study findings consistently supported the Fishbain Model of violence risk in pain patients.
  • The results underscore the necessity of psychological assessment and management for chronic pain patients.
  • While interventions were suggested, further research is required to validate their effectiveness in reducing patient violence.

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