1. 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

2. 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

3. 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

4. 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

5. 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)

6. 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

7. Sample - Health n % Anxiety, % 21 51.2 Arthritis, % 27 65.8
Back pain, %
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, %

8. Association of social network variables with pain and mental health variables, stratified by number of ACES
ACES <4 (n=26)
ACES≥4 (n=15)
Positive social network
Negative social network
Social network balance
Pain Level
0.04
0.44
-0.23
-0.01
-0.07
Distress Level
0.51
-0.33
-0.14
0.64
-0.46
PDS total
-0.40
0.36
-0.44
-0.09
0.10
PHQ-9 total
-0.16
0.26
-0.25
-0.28
0.52
-0.36
BAI-PC total
0.003
0.34
-0.19
0.18
0.43

9. 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

10. 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)

11. 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