Pain and Somatic Symptoms in Tortured Refugees : A Clinical Survey

Torture may be associated with long-lasting somatic symptoms, only partly explained by physical injuries. Physical pain as a result of torture may seriously complicate the diagnostics and treatment of posttraumatic pathology in refugees. The question whether a relation exists between the experience of torture and the extent of reported medically unexplained physical symptoms, is therefore highly relevant. We firstly hypothesized that refugees who underwent torture will report more somatic symptoms, as operationalized by experienced pain, than refugees without a history of torture.

Secondly, we hypothesized gender and region of origin to be significant risk factors. With the data set of a large clinical population of refugees (N=940), we examined specific pain items of a somatic complaints questionnaire (PILL), of a general symptom check list (HSCL-25), and of a trauma questionnaire (HTQ) in relation to torture reports. Pain scores on one item level were significantly higher in tortured refugees than in non-tortured refugees, on the other items not. In addition, gender moderated the relationship between reported torture and pain, with women reporting more physical symptoms than men. Region of origin had no influence on this relationship.

Torture as traumatization has a connection with somatic symptoms, which means that this can enhance the unnecessary use of somatic treatment modalities, if there is no somatic disorder present. Increasing motivation for psychological trauma treatment is a recommended approach, since refugees with torture experience and somatic symptoms without physical origin can profit from it.