Rehabilitating Torture Survivors - Dignity - Danish Institute Against ...

WORKSHOP 1: Controversies in Assessment(Wednesday Dec 3 Afternoon)Controversies in Assessment – Chronic PainInvited lecturerUwe Harlacher, PhD, Chief PsychologistRehabilitation and Research Centre for Torture Survivors,Copenhagen, DenmarkThe assessment and measurement of pain implies manifold problems and controversies.Instead of focusing on technical aspects of pain-measurement suchas suitability of various measurement-instruments and scales, some more generaland principle controversies and problems will be discussed. These controversiesand problems arise because pain is a complex phenomenon, interactingwith other variables.The presented controversies and problems are:a) Pain might rather be secondary or subordinated to other problems than acentral problem per se. Examples of this will be presented and discussed.b) Unsuitable measurement of physical performance: the standardized measurementof physical performance, e.g. pre and post treatment might give misleadingresults if not embedded in a wider context of everyday activities.c) Too narrow focus on pain: a maximum reduction of pain is not a given centralgoal of treatment.d) Ignoring of long-term-perspective: short term strategies for coping with painmight not be suitable in the long run.e) Ignoring of subgroups: the population of pain-patients is not homogenouswith respect for e.g. general activity, some are (too) active, other (too) lowactivewith consequences on suitable treatment goals and interpretation oftreatment-results.f) Activity shift within individuals/pacing: This relatively complex phenomenonis described as important for some cases but at the same time as difficult toassess and measure.The treatment-philosophy of ”Acceptance and Commitment Therapy”(respectively a short and pronounced sharp formulation of that philosophy)is discussed in connection with points c), d) and f). It is argued that, dependingon subgroup and other variables that characterize the pain-problem,the utility of this philosophy can vary greatly from highly applicable (point c) tocounterproductive (points d) and f)).ReferencesTurck DC, WinterF. The pain survival guide, how to reclaim your life. WashingtonDC: American Psychological Association, 2006.Mc Cracken LM. Contextual cognitive-behavioral therapy for chronic pain. IASPpress, 2005.Butler D, Mosley L. Explain pain. Noigroup Publications, 2003.13