Despite chronic pain typically developing in the aftermath of physical injuries, e.g. surgery or traffic accidents, chronic pain in the aftermath of torture-related physical injury is often overlooked and/or interpreted as secondary to psychiatric disorder like PTSD. In cooperation since 2010 between the Danish RCT - Rehabilitation and Research Centre for Torture Victims (renamed DIGNITY 2012) and the Transcultural Psychosocial Organization (TPO) Cambodia, a high prevalence of, typically torture related, pain has been observed among Cambodian torture survivors receiving rehabilitation at TPO.
An educational program on pain has been implemented at TPO and a culturally adapted version of a group based “pain school”' directly addressing pain-problems has been developed. The process of implementation of the educational program is described as well as the methodology and process of the development of the culturally adapted treatment manual. The outcome of the intervention has been researched in two pilot studies using pre-post designs with different target groups and treatment formats. Pain related motor disability measured by the Disability Rating Index (DRI) and various aspects of pain (e.g. intensity, impact on sleep) measured by the Brief Pain Inventory (BPI) were used as main outcome measures.
The outcome is currently further analyzed on data from a recently conducted randomized controlled trial (RCT) in which additional measures regarding PTSD and depression have been used allowing for the analysis whether the pain-addressing intervention also has an impact on other symptom areas.
It was possible to considerably increase the level of consciousness and knowledge about pain among the Cambodian addressees. The project succeeded also in engaging the Cambodian addressees in the production of a culturally adapted Pain School and to enable about 12 therapists to implement the intervention. The outcome of the first pilot trial shows a significant improvement in all outcome measures and the second trial even better results with large effect sizes. There were no clients indicating major negative outcome.
Only small differences were found in responsiveness regarding potential moderating factors like age, sex and rural/urban participants. It is concluded that the hypothesis that chronic pain is an important factor for the suffering of torture survivors in Cambodia is confirmed and that addressing the problem using a cost effective group based psychoeducational intervention reveals clinically significant results (with some reservation for the still ongoing analysis of the RCT-data).
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