April Gamble: "In Cape Town we'll have physiotherapists from all over the world. It’s such a unique opportunity"

Pain science provides answers as biomedical models to trauma and torture fail

A biopsychosocial approach to treating pain has helped April Gamble improve care for victims of torture and trauma in Iraq.



The United Nations currently estimates that there are 13 million refugees worldwide, and almost half are survivors of torture or trauma with physical and psychological impairments. And while ongoing international conflicts mean the number is set to rise, April Gamble, physiotherapist trainer at the Centre for Victims of Torture in Iraq, says that developments in modern pain science now allow therapists to offer more effective treatments than ever before.

"Modern pain science has changed our whole profession in lots of ways," says Gamble, who is leading a session on the subject at congress. "For me, personally, I feel like I wouldn’t be able to do this work without that background. I approach a lot of local therapists who are still currently practising in a biomedical model and they experience a lot of frustration because they don’t get outcomes with clients. The modern pain science approach really helps us understand all the factors involved with pain, involved with physical functioning, involved with mental health functioning."

Gamble and her team work at the The Centre for Victims of Torture, in the Kurdistan region, with patients who are often in the midst of active mental health crises. This requires a safe and stable environment - and relationship - before more conventional treatment can proceed. They first focuss on the mental health and cultural contexts, working through a patient's experience in order 'to help their reactions not be overwhelming any more'. 

"We’ve learned so much about pain in the last decade, and as a physiotherapy field we’ve really developed in our approach," says Gamble. "With this population the biopsychosocial approach is so essential because we really have to understand the psychological situation of our clients because they present with post-traumatic stress disorder, depression and anxiety. We're asking, how do we adapt that approach to survivors of torture and trauma?"

The question will be debated in detail in the focussed symposia on post-trauma pain, which Gamble chairs alongside speakers Justine Dee, Laila Jeanne Jacobsen, Anne-Mette Karrer and Jepkemoi Joanne Kibet. Gamble says that the international makeup of the panel shows that therapists from anywhere in the world could find themselves treating patients who have been affected by torture or trauma.

"The need is increasing significantly," she says. "The presenters that are with me are working in Denmark, Africa and the United States, so they’re from all over. And that's where survivors are located. Globally. Everywhere.

"In Cape Town we'll have physiotherapists from all over the world. It’s such a unique opportunity, to have people from all backgrounds sharing innovative ideas, asking where we want our to profession to go, and how we can use what we do best. What we do best is movement, and education, and therapeutic alliance. How can we use that to improve function in the long-term, and promote that self-management?"

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