Abstract
BackgroundTraumatized refugees often report significant levels of chronic pain in addition to posttraumatic stress disorder symptoms, and more information is needed to understand pain in refugees exposed to traumatic events. This study aimed to assess the frequency of chronic pain among refugee psychiatric outpatients, and to compare outpatients with and without chronic pain on trauma exposure, psychiatric morbidity, and psychiatric symptom severity.MethodsWe conducted a cross-sectional study of sixty-one psychiatric outpatients with a refugee background using structured clinical diagnostic interviews to assess for traumatic events [Life Events Checklist (LEC)], PTSD (Posttraumatic Stress Disorder) and complex PTSD [Structured Clinical Interview for DSM-IV PTSD Module (SCID-PTSD) and Structured Interview for Disorders of Extreme Stress (SIDES)], chronic pain (SIDES Scale VI) and psychiatric symptoms [M.I.N.I. International Neuropsychiatric Interview (M.I.N.I.)]. Self-report measures were used to assess symptoms of posttraumatic stress [Impact of Event Scale-revised (IES-R)], depression and anxiety [Hopkins Symptom Checklist (HSCL-25)] and several markers of acculturation in Norway.ResultsOf the 61 outpatients included, all but one reported at least one chronic pain location, with a mean of 4.6 locations per patient. Chronic pain at clinical levels was present in 66% of the whole sample of outpatients, and in 88% of the outpatients with current PTSD diagnosis. The most prevalent chronic pain locations were head (80%), chest (74%), arms/legs (66%) and back (62%). Women had significantly more chronic pain locations than men. Comorbid PTSD and chronic pain were found in 57% of the outpatients. Significant differences were found between outpatients with and without chronic pain on posttraumatic stress, psychological distress, and DESNOS severity.ConclusionsChronic pains are common in multi-traumatized refugees in outpatient clinics in Norway, and are positively related to symptomatology and severity of psychiatric morbidity. The presence of chronic pain, as well as comorbid chronic pain and PTSD, in psychiatric outpatients with a refugee background call for an integrated assessment and treatment for both conditions.
Highlights
Traumatized refugees often report significant levels of chronic pain in addition to posttraumatic stress disorder symptoms, and more information is needed to understand pain in refugees exposed to traumatic events
Chronic pain and traumatic exposures In our study of 61 psychiatric outpatients, forty (65.6%) reported chronic pain at clinical levels. This is three and a half times higher than rates of chronic pain found in the general population (19%) (Breivik et al 2006), similar to rates found in other investigations of refugee populations (Jamil et al 2006; Cheung 1994), and even still higher than a study of pain in refugees resettled in Sweden
Chronic pain and psychiatric symptomatology We found that outpatients with chronic pain at clinical levels had significantly more posttraumatic symptoms, this result is barely significant after adjustment for multiple testing
Summary
Traumatized refugees often report significant levels of chronic pain in addition to posttraumatic stress disorder symptoms, and more information is needed to understand pain in refugees exposed to traumatic events. Many refugees have been exposed to multiple traumas (Steel et al 2002; Elklit et al 1998) and are at high risk for developing Posttraumatic Stress Disorder (PTSD) (Roth et al 2006; Ai et al 2002; Lavik et al 1996; Ferrada-Noli et al 1998). The prevalence of pain in veterans seeking treatment for PTSD was found to be higher than the prevalence of PTSD in veterans seeking treatment for pain (Asmundson et al 2002) This difference may be explained by the nature of traumatic events that are often associated with physical injuries, such as war injuries or torture. The highest rates of chronic pain are found in torture exposed refugees (Carinci et al 2010; Thomsen et al 2000; Williams et al 2010), and chronic pain in tortured refugees has been found to have a strong impact on daily functioning (Prip et al 2011)
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