Chronic pain diagnosis in refugee torture survivors: A prospective, blinded diagnostic accuracy study

Abstract

Background An estimated 87% of torture survivors experience chronic pain such as brachial plexopathy from upper extremity suspension or lumbosacral plexus injury from leg hyperextension. However, a vast majority of pain is undetected by evaluators due to a lack of diagnostic tools and confounding psychiatric illness. This diagnostic gap results in exclusive psychological treatment rather than multimodal therapies, substantially limiting rehabilitation. We hypothesized that the United Nations Istanbul Protocol (UNIP) would have a sensitivity of approximately 15% for pain detection, and that the use of a validated pain screen would improve its sensitivity by at least 29%, as compared to the reference standard (pain specialist evaluation). Methods and findings This prospective blind-comparison-to-gold-standard study of survivors of torture, as defined by the World Medical Association, took place at Weill Cornell Medicine between February 1, 2017, and June 21, 2019. 11 women and 9 men, for a total of 20 participants, were included in the analysis. Five participants received 2 UNIP evaluations, for a total of 25 unique evaluations included in the analysis. Participants were representative of a global population, with home countries in Africa, Central America, South Asia, the Caribbean, and the Middle East. Methods of torture experienced were homogeneous, following the predictable pattern of systematic torture. Participants first received the standard evaluation protocol for torture survivors (UNIP) by a trained evaluator, and subsequently received a validated pain screen (Brief Pain Inventory-Short Form [BPISF]) followed by a noninvasive examination by a pain specialist physician (reference standard). The primary outcome was the diagnostic and treatment capability of the standard protocol (index test) versus the validated pain screen (BPISF), as compared to the reference standard. Trained evaluators performing the initial assessment with the UNIP (index test) were blinded to the study, and the pain specialist physician (reference standard) was blinded to the outcome of the initial UNIP evaluation and

Genetic diversity and main functional composition of Lingzhi strains from main producing areas in China

“…After reaching an 80% confluence, cells were incubated in polysaccharide (10 µg) dissolved in 100 µl DMEM (10% FBS, 100 U/ml penicillin/streptomycin) and at 37 °C and 5% CO 2 for 72 h. MTS method was used to measure the OD value at 490 nm by a microplate reader (MUITISKAN GO, Thermo Scientific). All data obtained were analyzed by Kruskal–Wallis test performed with R software, version 3.5.3 (R Foundation, Vienna, Austria) (Kaur et al 2020 ), p-values of less than 0.05 were considered to indicate statistical significance.…”

Group physiotherapy with survivors of torture in urban and camp settings in Jordan and Kenya

“…Many survivors have issues with chronic pain, even years after they have experienced torture (Amris et al, 2019). The location of pain is at times correlated with the type and location of torture, such as having foot pain after sustaining falanga torture (Prip et al, 2016), head pain after traumatic brain injury, shoulder pain following suspension, and pelvic and back pain following sexual torture (Amris et al, 2019;Baird et al, 2017;Kaur et al, 2020;Nordin & Perrin, 2019;Olsen et al, 2007;Tsur et al, 2020;Wang et al, 2016;Williams & Baird, 2016). .…”

“…These include: traumatic brain injuries, nerve injuries, injury to various parts of the body from beatings including those to the feet; burns; damage to the pelvic floor from sexual torture; fractures Group physiotherapy with survivors of torture in urban and camp settings in Jordan and Kenya and amputations (Amris et al, 2019;Prip et al, 2016). Further, many survivors of torture have issues with chronic pain, even years following their torture experiences (Harlacher et al, 2019;Kaur et al, 2020;Wang et al, 2016;Williams & Baird, 2016).…”

Challenges for Students in the Creation, Growth, and Management of an Academic, Student-run Asylum Clinic

“…Recognizing the wealth of data contained in the hundreds of affidavits already prepared for our clients, the WCCHR has performed a number of retrospective analyses and is planning other studies that use the existing database ( Ackerman 2019 ; Aguirre et al 2020 ). The WCCHR has also sought to capture our clients’ unique perspectives and experiences through survey projects and an interview-based study ( Geynisman-Tan et al 2019 ; Kaur et al 2020 ).…”