Acceptability and Barriers to Chronic Pain Treatment in Refugee Torture Survivors

Chronic somatic pain is prevalent in refugee torture survivors, yet it remains underdiagnosed and undertreated. Understanding the acceptability of and barriers to treatment is essential for facilitating access and improving care in this population.

To assess the acceptability of treatment for chronic somatic pain and to identify factors influencing treatment access among refugee torture survivors.

This qualitative study was conducted between September 20, 2021, and December 20, 2023. Interviews were thematically analyzed using a framework guided by the Gelberg-Andersen Behavioral Model of Healthcare Utilization for Vulnerable Populations. This study was conducted through the Weill Cornell Center for Human Rights (WCCHR), a large academic, medical-legal human rights center in the US serving a globally representative population of refugees. Adult refugee torture survivors aged 18 years or older with chronic pain as diagnosed by a specialist pain physician were included. Data were examined from December 2023 to October 2024.

Participants were asked about their attitudes toward 3 standard treatment modalities for chronic somatic pain, including nonopioid analgesics, trigger-point injections, and physical therapy.

Pain treatment acceptability and perceived barriers to treatment were categorized using the Andersen Model.

The 25 participants had a mean (SD) age of 37 (9.3) years, 18 (72%) were male, and 25 (100%) were asylum seekers representing 5 low-income United Nations regions. All participants were receptive to at least 1 of the proposed treatment modalities. Acceptability was primarily influenced by predisposing and need factors, including trust in the health care systems and a strong motivation to alleviate pain. However, multiple barriers impeded treatment uptake. These barriers were categorized as predisposing factors (eg, language barriers, cultural differences, and immigration status), enabling factors (eg, perceived inadequacies in insurance coverage, financial and work-related constraints, and logistical challenges), and need factors (eg, pain severity and the compounded stress of legal status).

Although refugee torture survivors are open to chronic pain treatment, this qualitative study suggests that systemic barriers hinder use. Addressing these barriers is essential for improving health care access in this vulnerable population.