Institute of Public Health, University of Southern Denmark, Odense, Denmark.
BMC Int Health Hum Rights. 2012 Dec 31;12:40. doi: 10.1186/1472-698X-12-40.
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.
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.
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.
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.
通过定量感觉测试（QST），我们最近发现，足底感觉功能在经历过或未经历 Falanga（足底殴打）的酷刑受害者之间没有差异。与匹配的对照组相比，酷刑受害者对深部机械伤害性刺激有痛觉过敏，对非伤害性皮肤刺激有感觉迟钝。本文的目的是将群体分析扩展到受害者足底的个体感觉特征，以探索外部暴力（酷刑）、报告疼痛、感觉症状和 QST 数据之间的可能关系，以帮助阐明潜在机制。
我们对 32 名来自中东的男性酷刑受害者进行了访谈和评估，包括疼痛和感觉症状以及由对患者是否暴露于 Falanga 情况不知情的研究者进行的 QST。疼痛强度、面积和刺激依赖性用于描述疼痛。QST 包括触觉、冷觉、温觉、冷痛觉、热痛觉、深部压痛和皮肤伤害性刺激的风激痛阈值。有一个种族匹配的对照组。我们从对照组数据中确定了正态性标准，即平均值 +/- 1.28SD，因此包括了所有值的 80%。QST 数据转化为与我们的正态范围相关的三个类别；感觉迟钝、感觉正常或感觉过敏/痛觉过敏。
大多数患者，无论是否暴露于 Falanga，行走时都报告有严重疼痛。这通常与深部机械压力的痛觉过敏有关。与麻木、烧灼感和深部机械痛觉过敏经常同时发生的机械刺激感觉迟钝，但除此之外，皮肤感觉模式的感觉迟钝与 Falanga、疼痛或感觉症状没有系统地同时发生。
在酷刑受害者中，似乎存在着压倒性的机制，表现为对压力疼痛的痛觉过敏，这通常被认为是中枢化的标志。此外，还有皮肤感觉迟钝，但由于与创伤的定位没有明显的相关性，这些发现可能表明感觉传递的中枢性紊乱，即中枢抑制。我们将这些发现解释为中央感觉处理变化的迹象，这是这些人慢性疼痛的统一病理机制。
