Special Considerations for the Treatment of Pain from Torture and War

Williams, Amanda C de C; Baird, E.S.

doi:10.1007/s40140-016-0187-0

Cited by 13 publications

(8 citation statements)

References 51 publications

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“…Many clients (66%) reported somatic complaints without a clear medical cause. It can be difficult to determine whether non-specific but chronic somatic complaints (including generalized pain, weakness and fatigue, and a weakened immune response) arise from physical damage caused by prolonged torture and incarceration in poor conditions, or have their origins in emotional distress (de C Williams & Baird, 2016). Such determinations are further complicated in sub-Saharan Africa where emotional distress is often communicated through idioms rooted in the body (Ventevogel, Jordans, Reis & de Jong, 2013).…”

Section: Results Of Case File Reviewmentioning

confidence: 99%

Towards a contextually appropriate framework to guide counseling of torture survivors in Sub-Saharan Africa

Higson-Smith

Eagle²

2018

Torture

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Introduction: If the right to rehabilitation is to become a meaningful reality for torture survivors in sub-Saharan Africa, it is necessary that counseling practice be responsive to the contextual and cultural demands of the region. Recent reviews of evidence-based practice with torture survivors are discussed with a focus on those approaches developed and/or tested with torture survivors in sub-Saharan Africa. Methods: The results of a mixed methods study of ongoing torture rehabilitation work are reported. This study incorporated a review of 85 case files of torture survivors treated at torture rehabilitation centers in three countries in sub-Saharan Africa, and in depth interviews with fifteen counsellorsand fourteen clients at those same centers. Quantitative data are presented in tabular form supported by uni- and bi-variate statistical analyses as appropriate. Qualitative data are presented in terms of themes identified through emergent coding. Results and discussion: Help-seeking torture survivors in this region are a diverse and highly symptomatic group, often struggling to survive with their families in precarious circumstances and under ongoing threat. In addition to incorporating key aspects of existing evidence-based practice, counselorsalso use a range of psychosocial approaches to assist torture survivors to protect and support their families in the face of seemingly overwhelming life challenges. We propose that more systematic methodologies that facilitate the inclusion of the voicesof clients and clinicians in ongoing international debates relating to evidencebased practice with torture survivors will enhance the application of such practices in diverse contexts.

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Section: Results Of Case File Reviewmentioning

confidence: 99%

Towards a contextually appropriate framework to guide counseling of torture survivors in Sub-Saharan Africa

Higson-Smith

Eagle²

2018

Torture

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“…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). .…”

Section: Chronic Pain In Survivors Of Torturementioning

confidence: 99%

“…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).…”

Section: Introductionmentioning

confidence: 99%

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

Gueron

Amoyi

Chao

et al. 2021

torture

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Introduction: In this paper we report provisional field results on the impact of CVT’s (the Center for Victims of Torture) interdisciplinary group treatment on physiotherapy indicators in refugees living in urban and camp settings in Kenya and Jordan. The physiotherapy component of this model includes pain neuroscience education, sleep hygiene, posture and body mechanics instruction and healing of pain and trauma from a biopsychosocial perspective, in a program of ten weekly sessions. This program is supported by a clinical assessment that records a broad set of indicators of participant experience and functioning. In addition, some survivors report having pelvic floor dysfunction and data will be offered about a subset of survivors looking at prevalence of these issues. Methods: Survivors are identified through referral systems, community education and sensitization campaigns, contacts and trainings with other NGOs and health care providers. Prospective survivors are screened into CVT services or referred to other agencies that can better meet their needs. CVT focuses its services on refugees with physical and emotional difficulties that may be effectively treated through its interdisciplinary treatment model and who have survived torture or related human rights violations. Following an informed consent process, survivors participate in a comprehensive individual assessment and then progress to the 10-week program. Wherever possible, follow-up assessments are conducted 2 weeks after the sessions end, and at 3, and 9 months following completion of the 10-week long intervention. Results: On average, participants who completed 3-month follow-up assessments showed statistically and clinically significant improvements on physiotherapy indicators. Discussion: Provisional results are encouraging and suggest that the model is adaptable to the needs of different populations and settings. As nearly all participants receive both counseling and physiotherapy, it is difficult to know which benefits can be attributed to physiotherapy alone.

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“…Most of the findings on CPPC regard other types of trauma (motor accidents, childhood abuse) and thereby reflect harm and context specific implications. Torture trauma sequela is distinct from other trauma experiences (de Williams & Baird, 2016) and there are many other compounding variables related to exile and displacement, such as social supports available and previous trauma history. Lastly, the psychometric instruments used in these studies are not validated cross-culturally proving problematic for generalisation (Patel et al, 2016).…”

Section: Limitationsmentioning

confidence: 99%

Painful memories: Challenges in trauma-focused therapy for torture survivors with PTSD and chronic pain

Dibaj

Halvorsen

Kennair

et al. 2020

torture

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Introduction: PTSD and chronic pain are disorders that researchers increasingly acknowledge to be risk factors that overlap and their comorbidity is associated with poorer treatment outcomes. This review focuses on torture survivors due to the high prevalence of comorbidity in this group, as well as how PTSD and chronic pain might develop, interact and mutually maintain each other. Methods: A narrative review of empirical studies and theoretical models regarding chronic pain and PTSD in torture survivors, informed by studies conducted in other contexts. Results and discussion: An overview of PTSD and chronic pain studies of torture survivors is presented. Treatment studies for torture survivors with PTSD are scarce and have been discouraging. Studies in other patient populations and theoretical models of main- taining factors within the cognitive-behavioral paradigm are presented, and focused around how interactions between PTSD and chronic pain might mitigate treatment of both disorders. Mutually maintaining factors between chronic pain and PTSD are presented as potential barriers to healing, and clinical implications involve suggestions for clinicians with intention to overcome these barriers in trauma-focused treatment of torture survivors. The knowledge base on how chronic pain and PTSD interact within the context of torture is still very limited.Torture is a potent risk factor in itself for both chronic pain and PTSD. Studies point to complex interactions between pain and PTSD across different trauma-exposed populations, especially when the trauma includes pain. Moreover, the coping strategies that are available and might function as some form of protection during torture [e.g. dissociation, withdrawal], might conversely function to exacerbate symptoms when the survivor is in a safe rehabilitation context. Observations combined with CPPC literature and recent developments in learning theory challenge clinical practice accordingly. Additionally, the limited knowledge base prevents us from providing clear-cut sugges- tions, particularly as the majority of scientific enquiry regarding chronic pain and PTSD has been conducted in other populations outside of the torture survivors group. Furthermore, cultural factors, specific needs and characteristics in this group, the human rights perspective and the socio-political context all need to be acknowledged. Trauma-focused treatment does not appear to specifically target all the mechanisms that are supposedly interacting in maintaining chronic pain and PTSD. Interdisciplinary rehabilitation and close collaboration between physiotherapists and trauma-focused therapists are warranted.

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Special Considerations for the Treatment of Pain from Torture and War

Cited by 13 publications

References 51 publications

Towards a contextually appropriate framework to guide counseling of torture survivors in Sub-Saharan Africa

Towards a contextually appropriate framework to guide counseling of torture survivors in Sub-Saharan Africa

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

Painful memories: Challenges in trauma-focused therapy for torture survivors with PTSD and chronic pain

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