The Treatment of Chronic Pain in Survivors of Torture and Refugee Trauma: an Integrative Approach

This webinar, presented on 2/22/2012, features Dr. Michael Grodin, Ellen Silver Highfield, and McKenna Mary Longacre, of the Boston Medical Center.

This webinar is part of the National Capacity Building (NCB) webinar series. NCB is a project of the Center for Victims of Torture.

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Average: 3 (2 votes)

Date: 

Wednesday, 22 February 2012

Webinar Summary and Resources

This webinar focuses on the potential alleviation of torture-induced chronic pain through alternative medicine and techniques. While the webinar is intended for medical professionals, it is accessible to a wider audience as well. After establishing that western conceptions both of pain and the necessity of pharmaceutical or surgical treatment are not universal, the webinar elaborates on a series of alternative medicines that have clinically and anecdotally been shown to be helpful. These include: the use of herbs, traditional Chinese medicine, cupping, yoga, acupuncture, and more. Ultimately, the webinar promotes “integrative medicine,” or a style of medicine in which western medicine and alternative medicine are complementarily combined in order to best serve the patient.  

We recommend that before watching the webinar, you watch this short (three and a half minute) video of the Complementary and Alternative Medicine Refugee Health Clinic at Boston Medical Center: http://www.bu.edu/bostonia/web/grodin/

Wong-Baker FACES pain scale

Additional Resources on Complementary and Alternative Medicine (CAM) and Refugees

http://nccam.nih.gov/

Highfield, E.S., et al., Acupuncture and Traditional Chinese Medicine for Survivors of Torture and Refugee Trauma: A Descriptive Report. J Immigrant Minor Health, 2011. Available for purchase, through SpringerLink.  

Abtract: Refugees with trauma histories are a difficult medical population to treat. Acupuncture care has gained acceptance in many mainstream hospitals in the United States, but research on acupuncture and refugee populations is limited. Herein, we report our experiences with 50 refugees (total acupuncture treatments = 425) at a major tertiary teaching hospital. Patients often reported extreme trauma including physical torture, rape and witnessing the same in family members. Patients represented 13 different countries, with about half the patients being Somali. The primary complaint of all patients was pain (100%). Using the Wong-Baker Faces Pain scale, 56% patients reported pain decreases. Patient acceptance of acupuncture was high. We provide three case histories as illustrative examples. Further research is warranted.


Grodin, M.A., et al., Treating survivors of torture and refugee trauma: a preliminary case series using qigong and t'ai chi. J Alternative Complement Med, 2008. 14(7): p. 801-6. Available for FREE on PubMed.

This paper seeks to explore the potential value of qigong and t'ai chi practice as a therapeutic intervention to aid in the treatment of survivors of torture and refugee trauma.Preliminary observations from four cases and a review of the literature support the potential efficacy of incorporating qigong and t'ai chi into the treatment of survivors of torture and refugee trauma.The incorporation of qigong and t'ai chi into the treatment of torture survivors, within a new framework for healing trauma, merits further investigation.

Benedict, A.L., L. Mancini, and M.A. Grodin, Struggling to meditate: Contextualizing integrated treatment of traumatized Tibetan refugee monks. Mental Health, Religion & Culture, 2009. 12(5): p. 485-499. Available for free through Harvard.

As a result of the recent resurgence of violence in the Tibetan Autonomous Region, the Boston Center for Refugee Health and Human Rights has an increased patient demographic: Tibetan refugee monks. Diagnosed by their amchis (traditional healers) as having a srog-rLung (life-wind) imbalance and presenting with posttraumatic stress disorder (PTSD), they struggle with their contemplative meditation, which—as a central focus of their daily lives—normally comes with ease. In this article, we consider the treatment implications of the highly relevant Buddhist context for this dual diagnosis. Specifically, we contextualise the classification of “religious impairment” as well as the significance of ongoing persecution of the devoutly religious for trauma therapy. We then draw upon spiritually oriented Eastern therapies as well as the confluence of specific paradigmatic practices to properly address these pathological intricacies in devising an effective holistic healing approach to the dual PTSD/srog-rLung diagnosis.

Pease, M., R. Sollom, and P. Wayne, Acupuncture for refugees with posttraumatic stress disorder: initial experiences establishing a community clinic. Explore (NY), 2009. 5(1): p. 51-4. Available for FREE through Tree of Life TaiChi.

This article describes the establishment of an acupuncture clinic to provide free treatments to Boston-based refugees suffering from PTSD. We provide a brief overview of PTSD as viewed from Traditional Chinese Medicine (TCM) and summarize the literature evaluating the use of acupuncture for PTSD. We discuss the treatment strategies employed in treating refugees and summarize a few case reports from the clinic.

Vallath, N., Perspectives on yoga inputs in the management of chronic pain. Indian J Palliative Care. 16(1): p. 1-7. Available for FREE on PubMed.

Chronic pain is multi-dimensional. At the physical level itself, beyond the nociceptive pathway, there is hyper arousal state of the components of the nervous system, which negatively influences tension component of the muscles, patterns of breathing, energy levels and mindset, all of which exacerbate the distress and affect the quality of life of the individual and family. Beginning with the physical body, Yoga eventually influences all aspects of the person: vital, mental, emotional, intellectual and spiritual. It offers various levels and approaches to relax, energize, remodel and strengthen body and psyche. The asanas and pranayama harmonize the physiological system and initiate a “relaxation response” in the neuro endocrinal system. This consists of decreased metabolism, quieter breathing, stable blood pressure, reduced muscle tension, lower heart rate and slow brain wave pattern. As the neural discharge pattern gets modulated, hyper arousal of the nervous system and the static load on postural muscle come down. The function of viscera improves with the sense of relaxation and sleep gets deeper and sustained; fatigue diminishes. Several subtle level notional corrections can happen in case the subject meditates and that changes the context of the disease, pain and the meaning of life. Meditation and pranayama, along with relaxing asanas, can help individuals deal with the emotional aspects of chronic pain, reduce anxiety and depression effectively and improve the quality of life perceived.

Kaptchuk, Ted. The web that has no weaver : understanding Chinese medicine. New York : Congdon & Weed : distributed by St. Martin's Press, 1983. Available for purchase through Amazon.com or other booksellers.

Moreno, A., L. Piwowarczyk, and M.A. Grodin. Human rights violations and refugee health. JAMA, 2001. 285(9): p. 1215. Available for FREE through JAMA.

Basoglu, M., Torture and its consequences : current treatment approaches. 1992, Cambridge; New York, NY, USA: Cambridge University Press. Available for purchase through Amazon.com or other booksellers.

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