Nordin Linda, Perrin Sean
Rehabilitation Department, DIGNITY - Danish Institute Against Torture, Copenhagen, Denmark.
Department of Psychology, Lund University, Lund, Sweden.
Eur J Psychotraumatol. 2019 Nov 11;10(1):1686807. doi: 10.1080/20008198.2019.1686807. eCollection 2019.
: Chronic pain is a common comorbid complaint in traumatized refugees seeking treatment for posttraumatic stress disorder (PTSD) and depression. However, the effect of comorbid pain on treatment remains under investigated. : To investigate whether pre-treatment pain (severity/interference) predicts outcomes in a multimodal treatment targeting PTSD, depression, anxiety, somatic complaints, and health-related disability in refugees exposed to torture and organized violence. Additional predictors were gender, age, and number of treatment sessions. : Participants were active cases at a specialist outpatient clinic for tortured refugees (n = 276; 170 men, 106 women) who were either on a treatment waitlist (mean length = 7.4 months, SD = 4.5), in treatment (mean length = 12.2 months, SD = 6.5), or who completed treatment and had (or were waiting for) a follow-up assessment. Participants completed symptom measures at referral, pre- and post-treatment, and 9-month follow-up. Multi-level mixed modelling was used to assess whether outcomes at post-treatment and 9-months were predicted by pain, gender, age, or the number of treatment sessions. : Treatment yielded significant pre-to-post-treatment reductions in PTSD, depression, anxiety, and number of pain locations, but no reductions in pain severity/interference, or health-related disability, except for societal participation. Gains for PTSD, depression, and societal participation were maintained at the 9-month follow-up. Higher levels of pain interference (but not severity) predicted poorer outcomes (PTSD, depression, and anxiety). Age, gender and number of treatment sessions did not predict outcomes, except for a small negative effect of (older) age on PTSD. : A growing body of literature suggests that pain and PTSD symptoms interact in ways to increase the severity and impact of both disorders in refugee and non-refugee populations alike. The present study suggests interference from pain can lessen the effectiveness of standard multi-modal treatments for refugees.
慢性疼痛是寻求创伤后应激障碍（PTSD）和抑郁症治疗的受创伤难民中常见的共病主诉。然而，共病疼痛对治疗的影响仍在研究中。
为了调查治疗前疼痛（严重程度/干扰程度）是否能预测针对遭受酷刑和有组织暴力的难民的PTSD、抑郁症、焦虑症、躯体主诉及与健康相关残疾的多模式治疗的结果。其他预测因素包括性别、年龄和治疗疗程数。
参与者是一家专门为受折磨难民开设的门诊诊所的活跃病例（n = 276；170名男性，106名女性），他们要么在治疗等候名单上（平均等候时间 = 7.4个月，标准差 = 4.5），要么正在接受治疗（平均治疗时间 = 12.2个月，标准差 = 6.5），要么已完成治疗并进行（或正在等待）随访评估。参与者在转诊时、治疗前、治疗后以及9个月随访时完成症状测量。采用多层次混合模型来评估治疗后和9个月时的结果是否由疼痛、性别、年龄或治疗疗程数预测。
治疗使PTSD、抑郁症、焦虑症及疼痛部位数量在治疗前后有显著减少，但疼痛严重程度/干扰程度或与健康相关的残疾（社会参与除外）没有减少。PTSD、抑郁症和社会参与方面的改善在9个月随访时得以维持。较高水平的疼痛干扰（而非严重程度）预示着较差的结果（PTSD、抑郁症和焦虑症）。年龄、性别和治疗疗程数不能预测结果，但（较大）年龄对PTSD有小的负面影响。
越来越多的文献表明，疼痛和PTSD症状以增加这两种疾病在难民和非难民人群中的严重程度和影响的方式相互作用。本研究表明疼痛干扰会降低针对难民的标准多模式治疗的效果。
