Pain and posttraumatic stress disorder in refugees who survived torture: The role of pain catastrophizing and trauma‐related beliefs

Abstract

Background Traumatized refugees with comorbid pain report more severe posttraumatic stress disorder (PTSD), respond less well to PTSD‐focused treatments and exhibit greater disability. A mutually maintaining relationship may exist between pain and PTSD, that may be partly accounted for by depression, but no prior studies have tested this assumption in traumatized refugees. Method Self‐report measures of pain, PTSD, depression, disability, pain catastrophizing (PC) and trauma‐related beliefs (TRBs) were administered to 197 refugees referred to the Danish Institute Against Torture (DIGNITY) prior to treatment. The contribution of pain, depression, PC, and TRBs to the overall variance in PTSD severity was examined. We also examined whether the relationship between pain and PTSD was mediated by PC and TRBs, after controlling for depression. Results Depression, pain severity, PC and TRBs together accounted for 66% of the overall variance in PTSD, with depression being the primary contributor (57%). In univariate tests, both PC and TRBs significantly mediated the relationship between pain interference/severity and PTSD. However, after controlling for depression only PC mediated this relationship. Conclusions Negative beliefs about pain and the trauma made small, but additive contributions to the relationship between pain and PTSD severity, after controlling for depression. Longitudinal studies with refugees, involving tests of more complex mutual maintenance models, are warranted. Significance After controlling for symptoms of depression, pain catastrophizing and negative trauma‐related beliefs partly mediated the relationship between pain and PTSD in tortured refugees. The results suggest that all three variables are important in a mutual mediation model of pain and PTSD, and as targets for treatment, in traumatized refugees.

Torture-survivors’ experiences of healthcare services for pain: a qualitative study

“…45 This is important in a population where such catastrophic beliefs are believed to contribute to the maintenance of comorbid pain and PTSD. 46,47 It was not clear what drove the overly biomedical approach to pain diagnosis and treatment; a question perhaps better explored through the clinician's lens. It is possible that barriers to effective communication, as discussed above, could lead to superficial exploration of torture-survivors' pain and suffering.…”

Pre-treatment pain predicts outcomes in multimodal treatment for tortured and traumatized refugees: a pilot investigation

“…The Danish Institute Against Torture (DIGNITY) is a self-governing institution with a governmentfunded clinic that provides inter-disciplinary, multimodal treatment targeting PTSD, depression, health problems and social integration in refugees who are survivors of torture or other organized forms of violence. Previous studies carried out with patients from this clinic have reported on the relationship between PTSD, chronic pain, and quality of life (Carlsson, Mortensen, & Kastrup, 2006;Harlacher et al, 2016;Olsen, Montgomery, Bojholm, & Foldspang, 2007), and that pain severity accounted for 66% of the variance in PTSD severity prior to treatment (Nordin & Perrin, 2019). In a preliminary fashion, the primary purpose of this study is to investigate the extent to which pre-treatment pain (severity and interference) predicts outcomes (PTSD, depression, and anxiety) in a multimodal treatment for refugees.…”

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). .…”