Gamble A1,2, Hartman J3, Mohammed Amin Ahmed A1,4, Saeed FK1, Omer Ismail H1, Van Gelder LH5
1Wchan Orgnization for Victims of Human Rights Violations, Kurdistan Region, Iraq, 2Side by Side Global, Kurdistan Region, Iraq, 3Northwestern University, Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, Chicago, United States, 4Sulaimani Polytechnic University, Technical College of Health, Kurdistan Region, Iraq, 5Dynamic Principles, LLC., Rockford, United States
Background: Pain is recognized as a contributor to disability globally, with survivors of torture demonstrating greater rates when compared to the normal population. Three decades of advancement in the science of the human pain experience has resulted in the improved treatment of it including a method of teaching about pain called therapeutic neuroscience education (TNE). TNE is based in the biopsychosocial framework and has resulted in improved clinical outcomes. In the Kurdistan region of Iraq (Kurdistan), where significant numbers of survivors of torture present with pain, treatments applying modern pain science and TNE are nonexistent. Historically, the Wchan Organization for Victims of Human Rights Violations (Wchan), a non-governmental Kurdish organization providing physical and psychological counseling/therapy for survivors of torture in a prison had not included modern pain science and TNE in their treatment approach.
Purpose: This case report describes a capacity building initiative with two objectives:
1) equip physiotherapists in Kurdistan with modern pain science clinical skills specific to survivors of torture and
2) develop and use TNE that reflect the clinical, cultural, and contextual needs of survivors of torture in the region.
Methods:
Results: A United-States trained doctor of physiotherapy facilitated two physiotherapists from Wchan in over 30 hours of capacity building specific to the clinical skills of modern pain science for survivors of torture. Contextually and culturally relevant TNE metaphors, stories, examples, pictures, and experiential learning opportunities were developed and implemented. Many biopsychosocial factors were considered when developing the TNE including commonly expressed maladaptive beliefs, comorbidities of psychological trauma, and previous clinical assessment data. Individual and group clinical assessments and clinical judgement of the physiotherapists revealed that the culturally adapted TNE increased the client's understanding of pain, contributing to the following: 1) improved physical, emotional, and social functioning, 2) decreased symptoms of central sensitization, 3) adaptive pain beliefs and behaviors, and 4) effective coping strategies. Competency evaluations demonstrated that the physiotherapists are competent in selecting and administering the innovative TNE as a component of individual and group treatment for survivors of torture.
Conclusion(s): Physiotherapists were equipped with modern pain science clinical skills and innovative TNE. This resulted in an enhanced treatment approach that reflects the unique culture and context of survivors of torture in the Middle East Region.
Implications: This case report describes a feasible model that can be used to empower physiotherapists working in unique cultural and contextual settings with the clinical skills and relevant TNE to effectively treat pain in vulnerable populations that are at risk for disability globally.
Keywords: Pain, Torture, Therapeutic Neuroscience Education
Funding acknowledgements: The UN Voluntary Fund for Victims of Torture
Purpose: This case report describes a capacity building initiative with two objectives:
1) equip physiotherapists in Kurdistan with modern pain science clinical skills specific to survivors of torture and
2) develop and use TNE that reflect the clinical, cultural, and contextual needs of survivors of torture in the region.
Methods:
- Development of a modern pain science training curriculum emphasizing the unique needs of survivors of torture.
- In-person trainings with Wchan's physiotherapists.
- Development of TNE by the physiotherapists in their native Kurdish language and in a manner that reflected the cultural, contextual, and clinical needs.
- Piloted TNE in individual and group physiotherapy treatment sessions and modified based on the physiotherapists' collaborative experiences.
- Integrated the innovative TNE into a group treatment approach for survivors of torture which is currently being studied by an Institutional Review Board-approved study.
Results: A United-States trained doctor of physiotherapy facilitated two physiotherapists from Wchan in over 30 hours of capacity building specific to the clinical skills of modern pain science for survivors of torture. Contextually and culturally relevant TNE metaphors, stories, examples, pictures, and experiential learning opportunities were developed and implemented. Many biopsychosocial factors were considered when developing the TNE including commonly expressed maladaptive beliefs, comorbidities of psychological trauma, and previous clinical assessment data. Individual and group clinical assessments and clinical judgement of the physiotherapists revealed that the culturally adapted TNE increased the client's understanding of pain, contributing to the following: 1) improved physical, emotional, and social functioning, 2) decreased symptoms of central sensitization, 3) adaptive pain beliefs and behaviors, and 4) effective coping strategies. Competency evaluations demonstrated that the physiotherapists are competent in selecting and administering the innovative TNE as a component of individual and group treatment for survivors of torture.
Conclusion(s): Physiotherapists were equipped with modern pain science clinical skills and innovative TNE. This resulted in an enhanced treatment approach that reflects the unique culture and context of survivors of torture in the Middle East Region.
Implications: This case report describes a feasible model that can be used to empower physiotherapists working in unique cultural and contextual settings with the clinical skills and relevant TNE to effectively treat pain in vulnerable populations that are at risk for disability globally.
Keywords: Pain, Torture, Therapeutic Neuroscience Education
Funding acknowledgements: The UN Voluntary Fund for Victims of Torture
Topic: Pain & pain management; Education: continuing professional development
Ethics approval required: Yes
Institution: Northwestern University
Ethics committee: Northwestern University's Institutional Review Board
Ethics number: STU00206726
All authors, affiliations and abstracts have been published as submitted.
