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Board D1,2, Childs S2, Boulton R1
1St George's, University of London and Kingston University, London, United Kingdom, 2Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
Background: Torture continues to occur in over 140 countries worldwide. The physical, psychological and social consequences of torture on its survivors are numerous and interconnected. Persistent pain resulting from torture is highly prevalent and impactful, with increasing numbers of torture-survivors presenting to healthcare services with pain-related issues. However, our understanding of pain resulting from torture is lacking and it is often misunderstood in both clinical and research settings. Subsequently, current service-provision may be falling short.
Purpose: To gain a deeper understanding of persistent pain from the perspective of torture-survivors; exploring pain beliefs and experiences and expectations of services for managing pain.
Methods: Thirteen participants were recruited from a specialist pain clinic in the UK set up to help torture-survivors manage their persistent pain. Utilising an ethnographic approach, data was collected via clinic observations, interviews and medical records and analysed via inductive thematic analysis.
Results: Seven themes emerged from the data: role-taking inthe patient-clinician relationship; multiplicity of diagnoses and treatments; lack of service integration; mixed expectations underpinned by hope; negative pain beliefs; belief forming; communicating pain. An interconnected picture appeared between themes, with past healthcare experiences and role-taking in the patient-clinician relationship influencing future expectations. Past experiences such as the multiple biomedical diagnoses received, the lack of recognition of torture when diagnosing and treating pain, and barriers experienced in accessing services, shaped participants´ future expectations of services and informed negative pain beliefs including fear and catastrophisation. Communicating pain was complex, with pain and torture experience influencing the language used to describe pain.
Conclusion(s): Torture-survivors struggling with persistent pain currently occupy a precarious position within the healthcare system; lack of recognition of torture experience when diagnosing and treating pain, alongside the dualistic organisation of many services and barriers to accessing them, can lead to unsuccessful treatment outcomes. Negative pain beliefs are common and appear shaped by experiences of healthcare, in particular through the provision of biomedical diagnoses. However, torture-survivors demonstrate resilience in their hopeful expectations of future treatment.
Implications: Clinical implications include the need for more joined up services, with provision of care that recognises torture experience and its biopsychosocial consequences. Strategies to engage and empower torture-survivors in the management of their pain are also recommended. Future research should consider the contributing roles of torture and healthcare experience in shaping pain beliefs.
Keywords: Survivors of Torture, Pain, Pain Beliefs
Funding acknowledgements: Funding for this study came from the National Institute for Health Research (NIHR) and Chelsea and Westminster Hospital Pain Clinic.
Purpose: To gain a deeper understanding of persistent pain from the perspective of torture-survivors; exploring pain beliefs and experiences and expectations of services for managing pain.
Methods: Thirteen participants were recruited from a specialist pain clinic in the UK set up to help torture-survivors manage their persistent pain. Utilising an ethnographic approach, data was collected via clinic observations, interviews and medical records and analysed via inductive thematic analysis.
Results: Seven themes emerged from the data: role-taking inthe patient-clinician relationship; multiplicity of diagnoses and treatments; lack of service integration; mixed expectations underpinned by hope; negative pain beliefs; belief forming; communicating pain. An interconnected picture appeared between themes, with past healthcare experiences and role-taking in the patient-clinician relationship influencing future expectations. Past experiences such as the multiple biomedical diagnoses received, the lack of recognition of torture when diagnosing and treating pain, and barriers experienced in accessing services, shaped participants´ future expectations of services and informed negative pain beliefs including fear and catastrophisation. Communicating pain was complex, with pain and torture experience influencing the language used to describe pain.
Conclusion(s): Torture-survivors struggling with persistent pain currently occupy a precarious position within the healthcare system; lack of recognition of torture experience when diagnosing and treating pain, alongside the dualistic organisation of many services and barriers to accessing them, can lead to unsuccessful treatment outcomes. Negative pain beliefs are common and appear shaped by experiences of healthcare, in particular through the provision of biomedical diagnoses. However, torture-survivors demonstrate resilience in their hopeful expectations of future treatment.
Implications: Clinical implications include the need for more joined up services, with provision of care that recognises torture experience and its biopsychosocial consequences. Strategies to engage and empower torture-survivors in the management of their pain are also recommended. Future research should consider the contributing roles of torture and healthcare experience in shaping pain beliefs.
Keywords: Survivors of Torture, Pain, Pain Beliefs
Funding acknowledgements: Funding for this study came from the National Institute for Health Research (NIHR) and Chelsea and Westminster Hospital Pain Clinic.
Topic: Pain & pain management; Mental health
Ethics approval required: Yes
Institution: UK Health Research Authority
Ethics committee: London Brent NHS Research Ethics Committee
Ethics number: 18/LO/0420
All authors, affiliations and abstracts have been published as submitted.
