title: Persistent pain in survivors of torture: a cohort study.
abstract: BACKGROUND
  Refugee survivors of torture in the United Kingdom have multiple problems, of which pain may be underrecognized, given the high prevalence recorded in similar populations in Denmark.
  
  
  OBJECTIVE
  To establish in a UK sample the prevalence of persistent pain and to investigate associations between specific pains and torture methods.
  
  
  METHODS
  A cohort of a random 20% sample attending a specialist UK center for survivors of torture in 2005 was taken. All complaints of pain recorded at initial interview were categorized for body site and putative pain mechanism. These were compared with the database of personal variables and data on torture using odds ratios (ORs) and exact probability.
  
  
  RESULTS
  Of 115 men and 63 women, with mean age of 30 years, 78% reported persistent multiple pains, mainly in the head and low back. They had experienced a median of six torture methods. There was a clear association between female abdominal/pelvic/genital pain and rape/sexual assault (17 of 34 vs. zero of 17: exact P<0.001) and between male anal pain and rape (two of nine vs. two of 77: OR=6.00; 95% confidence interval=1.79-20). Tests of foot/leg pain with falaka and shoulder pain with suspension did not show expected associations.
  
  
  CONCLUSIONS
  A significant relationship emerged between torture and report of persistent pain at a high prevalence. Findings do not support the widespread clinical assumption that complaint of persistent pain after torture is predominantly a manifestation of psychological distress. Rather, complaints of pain in torture survivors should be assessed and treated in relation to physical trauma.
authors.affiliation: Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom. amanda.williams@ucl.ac.uk
authors.forename: Amanda C de C
authors.initials: AC
authors.lastname: Williams
authors.forename: Cristian R
authors.initials: CR
authors.lastname: Peña
authors.forename: Andrew S C
authors.initials: AS
authors.lastname: Rice
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D015995:Prevalence; D011902:Rape / Q000523:psychology*; D012036:Refugees / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D017741:Survivors / Q000523:psychology*; D014104:Torture / Q000523:psychology / Q000706:statistics & numerical data*; D006113:United Kingdom