The effective management of chronic pain is rendered difficult by a variety of
potential pre-existing variables, by current interpersonal functioning, and by perception of the experience itself. As Herman and Baptiste (1990, cited in Tunks et aI., 1990) put it, the wayan individual construes his/her experience determines his/her personal meaning of pain. Further, the manner in which an individual copes with pain is influenced by the available coping strategies. Therefore it is relevant to explore the effective management of the pain experience along two dimensions: individuals' perceptions of their own experience and the ability to access adaptive coping strategies.
The only good way to resolve the question of causality, as discussed by Pope and Hudson (1995) would be to perform a prospective study. However, this design would clearly be unethical in our situation; one cannot deliberately sexually abuse a group of people in order to see what happens to them. An alternative to this would be to identify a cohort of children who were known to be severely abused and whose abuse was contemporaneously documented. Once this group was identified, a carefully matched group of children, coming from similar homes, with similar degrees of familial psychopathology (to control for genetic factors) would be identified. Ideally, only the factor of sexual abuse would differentiate one group from the other. The investigators would then follow the two groups longitudinally. Certainly such a study, in the opinion of Pope and Hudson (1995) would be expensive, take many years to execute and be fraught with potential ethical mandates that could terminate the study. The current sum
of investigations in this area has offered much enlightenment regarding mediating variables. Perhaps further elucidation of these variables can offer solutions to the ethical and practical problems of a definitive longitudinal investigation.
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