Understanding pain from torture: Cultural considerations

Abstract

This paper aims to highlight some problems that can complicate effective clinical management of chronic pain in survivors of torture. Drawing from both psychological and anthropological literature as well as from clinical experience, we argue that in treatment settings, cultural considerations must come into play when dealing with chronic pain patients from countries where torture might occur, particularly in light of increasing global migration. Despite being outlawed in many countries, torture remains a common practice worldwide. Repetitive injuries and severe acute pain, as experienced by many survivors, can lead to lasting impairment and persistent pain. Torture does not necessarily leave definite traces on a survivor’s body, and in the clinic the connection between persistent pain and torture is often missed. Because of its invisibility, communicating pain is difficult - if not impossible - and the same holds true for the consequences of torture. Patients may, for various reasons, be unable, or unwilling, to disclose this aspect of their history, and clinicians should attempt to be sensitive to this. Concepts of physical wellbeing and mental health vary across cultures, and the notion of normal functioning should be carefully re-examined in the pain management context. The consequences of torture cannot easily be divided into physical/ psychological. Many tools that aim to assess the psychological impact of torture fail to do so in the appropriate sociocultural context; however, there is a positive trend in pain research towards a more culturally sensitive approach.