Torture mechanisms and chronic somatic pain in US refugees.

Editor—There are >100 million global refugees according to the United Nations, 44% of whom have experienced torture. 1 Higson-Smith C. Updating the estimate of refugees resettled in the United States who have suffered torture 2015. Available from https://www.cvt.org/sites/default/files/SurvivorNumberMetaAnalysis_Sept2015_0.pdf (accessed 23 February 2023). Google Scholar The USA is the highest recipient of asylum applications, 2 United Nations High Commissioner for Refugees. Global trends: forced displacement in 2021. Available from https://www.unhcr.org/62a9d1494/global-trends-report-2021 (accessed 23 February 2023). Google Scholar and healthcare providers there and in other resource-rich nations are increasingly likely to see refugee patients in their clinical practices. We previously found that 85% of torture survivors experience chronic somatic pain, such as brachial plexopathy from upper extremity suspension or lumbosacral plexus injury from leg hyperextension; however, this pain was most frequently misdiagnosed by providers as a manifestation of post-traumatic stress disorder (PTSD), major depressive disorder (MDD), or psychosomatisation. 3 Kaur G. Weinberg R. Milewski A.R. et al. Chronic pain diagnosis in refugee torture survivors: a prospective, blinded diagnostic accuracy study. PLoS Med. 2020; 17e1003108 Crossref Scopus (9) Google Scholar Several gaps remain in our understanding of pain after torture, such as whether this pain accords with the mechanism of injury. Moreover, the long-term morbidity of torture-related somatic pain has not been characterised, and evidence-based treatments are lacking. We conducted an analysis of chronic somatic pain after torture to define the concordance of pain with mechanism of injury, and to identify prevalence and modalities of treatment for this pain.