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Expert Voices

Helping Physiotherapists Examine the Ways Torture Survivors Think About Pain

Published April 27, 2016

Jepkemoi Kibet is a physiotherapist/trainer at CVT Kenya.

Pain is one of the many problems to be addressed in survivors of torture. And in my work as a physiotherapist trainer at CVT, every day I attend to clients with chronic pain as a result of torture. 

I recently had the privilege of presenting at the International Conference of Physical Therapy in Psychiatry and Mental Health in Madrid. Along with Julie Phillips, from the Department of Physiotherapy at University of the Western Cape, South Africa, I presented on the “Cross Cultural Adaptation and Validation of the Pain Catastrophizing Scale (PCS) among Victims of Torture.” The role of catastrophization in the development of chronic pain has gained a considerable amount of attention in research over the past few decades, so our topic was quite timely.

The Pain Catastrophizing Scale is a self-administered questionnaire that consists of 13 items that assess the ways those who experience chronic pain think about it and internalize it. “Catastrophizing” is the process of amplifying pain and ruminating on it, which can cause people to feel more helpless in dealing with their pain. The scale is divided into three domains: helplessness, magnification and rumination. The 13 items on the scale include: “I worry all the time about whether the pain will end,” “It’s terrible and I think it’s never going to get any better” and “There is nothing I can do to reduce the intensity of the pain.” Responses to these prompts give researchers good information about how the individual thinks and feels about his or her pain and how much time they spend focused on it.

This scale has been widely used in the research of chronic pain and pain behavior in patients with low back pain, which is experienced by many torture survivors. Research has shown that those, like torture survivors, who experience chronic pain can reduce symptoms like depression following treatment if they are able to change their thinking and reduce their levels of catastrophizing (Spinhoven et al., 2004).

Our presentation was attended by more than 60 physiotherapists from 11 countries. While the majority of them currently work with refugees or asylum seekers in their countries, others worked with refugees previously. Some others attended because they work with patients with chronic pain.

The response to the presentation was positive and exciting because this was the first time there was a paper from Africa talking about torture survivors, even though most refugees treated by the physiotherapists came from Africa.

Attendees were interested in my personal experience working with torture survivors in CVT Kenya. They wanted to know how long the program has been running in Kenya, how many clients we see for physiotherapy and the common types of torture among survivors. Because this was also the first time they had someone from Africa present about torture, I was asked to elaborate on the treatment model we use in CVT and our collaboration between psychotherapists and physiotherapists. They were also happy to learn that there is a Swahili version of the Pain Catastrophizing Scale. In particular, attendees wanted to know more about our measurements at CVT: how we know that clients are getting better and which tools we use for assessments.

I encourage physiotherapists working in this field to attend such conferences in the future. Important information is shared, including the latest thinking on this type of tool. Most torture survivors suffer chronic pain, so other physios working with torture survivors will appreciate the important role catastrophizing plays in the development of pain chronicity.

This was my first time presenting in an international forum, so I was honored that my abstract was accepted and that I could attend. Participating in the round table discussion where global issues affecting refugees were discussed and leading the discussion on the prevalence of torture among refugees in East Africa was particularly rewarding.


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