Clinical findings in men with chronic pain after falanga torture.
OBJECTIVE
To explore clinical findings in men with chronic pain after falanga torture as compared with controls, and to try to understand the nature of the pain mechanisms responsible.


METHODS
Eleven male torture victims from the Middle East with chronic pain after falanga, and 11 age, sex, and ethnically matched controls with no history of torture were recruited. All participants were interviewed regarding pain characteristics in the feet and lower legs at rest and when walking. Structural changes and motor and sensory function were clinically assessed according to a standardized protocol. The walking pattern was observed for compensatory gait patterns.


RESULTS
The torture victims had pain in their feet and lower legs and a compensated gait pattern, usually with severe pain during walking. Reduced light touch and thermal sensation, tactile dysesthesia, allodynia, and tenderness on palpation were common findings. Structural changes in the feet were found in more than half of the victims, but did not correlate with pain reports. These clinical findings were nonexistent or seen only rarely in controls.


CONCLUSIONS
We found clear clinical signs of nerve injury in the feet. The sensory findings indicated 2 neuropathic pain mechanisms, one dominated by a peripheral pain generator and other by irritative phenomena (dysesthesia, allodynia), indicating central sensitization. It is reasonable to assume that these changes are due to the falanga exposure. A nociceptive contribution cannot be excluded. It is important to perform an individual diagnostic analysis to facilitate adequate treatment.
Prip
Karen
K
Rehabilitation and Research Centre for Torture Victims, Copenhagen, Denmark. kp@rct.dk
Persson
Ann L
AL
D000328:Adult; D000344:Afferent Pathways / Q000503:physiopathology; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D002908:Chronic Disease; D004185:Disability Evaluation; D036981:Fasciitis, Plantar / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D005528:Foot / Q000294:innervation / Q000473:pathology / Q000503:physiopathology*; D018409:Foot Injuries / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D020233:Gait Disorders, Neurologic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006930:Hyperalgesia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008877:Middle East; D009619:Nociceptors / Q000503:physiopathology; D010147:Pain Measurement; D010148:Intractable Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D059348:Peripheral Nerve Injuries; D010525:Peripheral Nerves / Q000503:physiopathology*; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D012678:Sensation Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D013995:Time; D014104:Torture