# Rethinking Assessment and Recovery: Understanding the Complexity of Pain in Torture-Related Suffering - Savonia AMK

> Based on literature review, victims of torture suffer from pain and complex biopsychosocial adverse health outcomes.

## The Complexity of Torture-Related Pain
Torture is a heinous crime that severely impacts the physical and mental health, quality of life, and social environment of survivors. Survivors of torture (SoT) frequently experience persistent pain alongside PTSD, depression, and anxiety. This suffering is often exacerbated by pre- and post-migration stressors, such as the insecurity of asylum status, economic hardship, social isolation, language barriers, and lack of access to medical or legal services.

Pain in this context is a multidimensional experience that extends beyond simple nociception. It is shaped by trauma-related factors, including the specific mechanisms and circumstances of the torture. Furthermore, the combination of persistent pain and mental health conditions often leads to central sensitization or dysregulated stress responses.

## Challenges in Assessment and Treatment
Current professional practices often fail to address the full spectrum of a survivor's experience. Pain is frequently dismissed or treated as a separate issue from mental health or social welfare concerns. This fragmentation leads to inadequate assessment and rehabilitation. 

Commonly used structured tools, such as pain questionnaires, often focus narrowly on symptom intensity or interference rather than the patient's broader psychosocial reality. Effective assessment requires a multidimensional approach that incorporates cultural and language sensitivity, trauma history, and an understanding of the patient's personal beliefs and attitudes.

## Thesis Overview and Methodology
This master’s thesis, conducted in collaboration with the Helsinki Deaconess Foundation’s Center for Psychotraumatology, aimed to describe existing assessment methods for SoTs suffering from co-morbid pain and to evaluate the role of quality of life in current literature.

The study utilized a descriptive literature review and thematic analysis of 14 sources. Seven themes were identified:
* Symptom Management and Coping Strategies
* Symptom Interference and Daily Functioning
* Understanding Individual’s Background and Trauma History
* Social Participation and Integration
* Diagnostic Properties and Symptom Characteristics
* Physiological Measures and Functional Assessment
* The Role of Quality of Life

## Key Findings
The results indicate that current assessment processes are primarily focused on symptom interference, diagnostic features, and the collection of personal data. There is a significant lack of focus on symptom management, self-efficacy, and quality of life. While the literature confirms that quality of life is low among this patient group, existing assessment tools rarely evaluate this factor.

## Future Directions for Healthcare
As global instability and migration increase, healthcare professionals must be prepared to encounter survivors of torture. The current lack of comprehensive medical and legal assessment standards—such as ruling out physical injuries like fractures or brain trauma—must be addressed. Future clinical practice and research should prioritize patient-centered strategies that emphasize individual coping skills and holistic quality of life.

## Authors
* **Pieta Myllykangas**, Master’s Degree in Global Public Health student, Savonia University of Applied Sciences
* **Maria Luojus**, Principal lecturer, Savonia University of Applied Sciences

## References
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