Pain when walking: individual sensory profiles in the foot soles of torture victims - a controlled study using quantitative sensory testing

BMC International Health and Human Rights

Bengt H Sjölund²  Ann L Persson³  Karen Prip¹ 

[1] Institute of Public Health, University of Southern Denmark, Odense, Denmark;Beritta Gurrisgatan 21, Malmö, SE, 21775, Sweden;Rehabilitation and Research Centre for Torture Victims, Copenhagen, Denmark

关键词: Torture;    Sensitization;    Nerve injury;    Falanga;    Chronic pain;   

Others  :  855393
DOI  :  10.1186/1472-698X-12-40

 received in 2012-05-24, accepted in 2012-12-28,  发布年份 2012

【 摘 要 】

Background

With quantitative sensory testing (QST) we recently found no differences in sensory function of the foot soles between groups of torture victims with or without exposure to falanga (beatings under the feet). Compared to matched controls the torture victims had hyperalgesia to deep mechano-nociceptive stimuli and hypoesthesia to non-noxious cutaneous stimuli. The purpose of the present paper was to extend the group analysis into individual sensory profiles of victims’ feet to explore possible relations between external violence (torture), reported pain, sensory symptoms and QST data to help clarify the underlying mechanisms.

Methods

We employed interviews and assessments of the pain and sensory symptoms and 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. QST included thresholds for touch, cold, warmth, cold-pain, heat-pain, deep pressure pain and wind-up to cutaneous noxious stimuli. An ethnically matched control group was available.The normality criterion, from our control group data, was set as the mean +/− 1.28SD, thus including 80% of all values.QST data were transformed into three categories in relation to our normality range; hypoesthesia, normoesthesia or hyperesthesia/hyperalgesia.

Results

Most patients, irrespective of having been exposed to falanga or not, reported severe pain when walking. This was often associated with hyperalgesia to deep mechanical pressure. Hypoesthesia to mechanical stimuli co-occurred with numbness, burning and with deep mechanical hyperalgesia more often than not, but otherwise, a hypoesthesia to cutaneous sensory modalities did not co-occur systematically to falanga, pain or sensory symptoms.

Conclusion

In torture victims, there seem to be overriding mechanisms, manifested by hyperalgesia to pressure pain, which is usually considered a sign of centralization. In addition there was cutaneous hypoesthesia, but since there was no obvious correlation to the localization of trauma, these findings may indicate centrally evoked disturbances in sensory transmission, that is, central inhibition. We interpret these findings as a sign of changes in central sensory processing as the unifying pathological mechanism of chronic pain in these persons.

【 授权许可】

   
2012 Prip et al.; licensee BioMed Central Ltd.

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