Physiotherapy for torture victims I: Chronic pain in torture victims: Possible mechanisms for the pain

Prip, K. & Amris, K. Torture Quarterly: Journal on Rehabilitation of Torture Victims and Prevention of Torture, 10(3), 73-76.
 
This article was reviewed by doctoral physical therapy student, Angela Pitar, from the University of Minnesota, 2014. 
 
A link to the article from the Dignity-Danish Institute Against Torture library is below.
 
Background - Throughout the years, several chronic muscular pain syndromes have been described in victims of torture with common findings of:  regional or diffuse pain in the musculoskeletal system often associated with poor sleep, tiredness, paresthesia, headache, and irritable symptoms from the gut and bladder. Causes of chronic pain in torture survivors as well as treatment implications for physiotherapists are described in detailed in the article.
  • Causes and mechanisms of chronic pain are explained for peripheral neuroplasticity, spinal neuroplasticity, and plasticity in the brain.
  • Pain mechanisms in chronic muscular pain syndromes are explained for chronic myofascial pain syndrome, and fibromyalgia syndrome
Possible pain mechanisms in torture victims -  
  1. Nociceptive pain elicited from peripheral nociceptors
  2. Neurogenic pain caused by a nerve lesion
  3. Altered central pain modulation
  4. Psychosomatic pain
Treatment - studies have shown that the most effective treatment for chronic pain is given by a multidisciplinary approach offering:
  1. Educating the patient on the basic physiology of pain and the psychological aspects of pain and pain behavior
  2. Teaching the patient how to handle his own pain, for instance by use of relaxation techniques
  3. Pharmacological treatment of pain
  4. Social advice
  5. Physiotherapy
Conclusion-  The concept that the torture victim is a chronic pain patient, together with the existing knowledge of the treatment of chronic pain patients in general, further underlies the need for the availability of such treatment.

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