1The Bob Shapell School of Social Work, Tel Aviv University, Israel 2Department of Physical Therapy, School of Allied Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Studies suggest that torture survivors often suffer long-term chronic pain and increased pain perception. However, it is unclear whether the actual experience of torture, or rather the subsequent posttraumatic stress disorder (PTSD), explains these pain problems. Furthermore, while catastrophic and fearful orientations to pain have been suggested to play a significant role in the association between trauma and pain, the underlying mechanisms remain unclear. This study examined whether chronic pain and pain perception among torture survivors are associated with torture experience or PTSD and whether catastrophic and fearful orientations mediate or moderate these associations.
Fifty-nine ex-prisoners of war who underwent torture and 44 matched veterans participated in this study. Pain perception was evaluated by assessing pain-threshold, and reactivity to experimental suprathreshold noxious stimuli. Participants completed self-administered questionnaires assessing PTSD, chronic pain, pain catastrophizing, and fear of pain.
While chronic pain was associated with PTSD (.44<β<.49; p<.002), increased pain perception was correlated with torture (.33<β<.65; p<.05). Pain catastrophizing was found to mediate the association between PTSD and chronic pain (β=.18, .19; p<.05). Fear of pain moderated the association between torture and pain perception (β=.41, .42; p<.017).
The findings suggest that chronic pain is contingent upon the psychological toll of torture, i.e. PTSD. This study also indicates that PTSD exacerbates catastrophic orientation, which in turn may amplify chronic pain. Reactivity to experimental noxious stimuli was related to prior experiences of torture, which enhances perceived pain intensity when interacting with a fearful pain orientation. These findings highlight the significance of orientation to bodily experiences following trauma.