Abstract
BackgroundFalanga torture (beatings on the foot soles) produces local chronic pain and severe walking difficulties. We have previously reported signs of neuropathic pain in the feet of falanga victims. The objective here was to clarify underlying pain mechanisms by quantifying sensory impairments in the feet of torture victims who had experienced both generalized torture and those who had been exposed to falanga in addition. An ethnically matched control group was available.MethodsWe employed quantitative sensory testing (QST) by investigators blinded to whether the patients, 32 male torture victims from the Middle East, had (n=15), or had not (n=17) been exposed to falanga. Pain intensity, area and stimulus dependence were used to characterize the pain as were interview data on sensory symptoms. QST included thresholds for touch, cold, warmth, cold-pain, heat-pain, deep pressure pain and wind-up to cutaneous noxious stimuli in the foot soles. Clinical data on anxiety and depression were retrieved.ResultsAlmost all falanga victims had moderate or strong pain in their feet and in twice as large an area of their foot soles as other torture victims. One-third of the latter had no pain in their feet and many reported slight pain; in spite of this, there were no differences in foot sole QST data between the tortured groups. A comparison with normal data indicated that both tortured groups had hypoesthesia for all cutaneous sensory fibre groups except those transmitting cold and heat pain, in addition to deep mechano-nociceptive hyperalgesia.ConclusionA comparison of the QST data between victims having been exposed to generalized torture and victims who in addition had been exposed to falanga, showed no differences on the group level. The sensory disturbances in relation to our control group are compatible with central sensitization and de-sensitization, pointing to a core role of central mechanisms. A further analysis to create individual sensory profiles from our measurements is in progress.
Highlights
Falanga torture produces local chronic pain and severe walking difficulties
It turned out that 17 patients had not been exposed to falanga (NF) and 15 had been exposed to falanga (F)
The not exposed to falanga (NF) victims had been tortured for the first time during the years 1979–2000 and had spent a median of 180 days in prison, whereas the F victims had been tortured for the first time during the years 1989–1996 and had spent a median of 365 days in prison
Summary
Falanga torture (beatings on the foot soles) produces local chronic pain and severe walking difficulties. We have previously reported signs of neuropathic pain in the feet of falanga victims. The objective here was to clarify underlying pain mechanisms by quantifying sensory impairments in the feet of torture victims who had experienced both generalized torture and those who had been exposed to falanga in addition. The use of falanga (beatings on the soles of the feet) is a torture method which deliberately aims at inflicting intense pain in the feet and lower legs [1,2]. The pathophysiological mechanisms of the chronic pain after falanga have puzzled clinicians and researchers. Some have hypothesized that a plantar closed compartment syndrome was the cause of pain and resulted in being unable to walk more than short distances [2,9,10]. Fractures of metatarsal bones and aseptic bone necrosis have been reported [14,15]
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