Applying Biopsychosocial- Spiritual and Trauma-Informed Pain Treatments in the Middle East & Northern Africa


Anne-Mette Karrer
International Programmes, DIGNITY- Danish Institute Against Torture, Denmark
April Christine Gamble
International Programmes, DIGNITY- Danish Institute Against Torture, Denmark


 A biopsychosocial & spiritual (BPSS) and trauma-informed (TI) treatment approach of chronic pain is needed for physiotherapy to result in functional improvements for persons impacted by trauma. In the Middle East and North Africa (MENA) many are impacted by trauma, but physiotherapists are taught a biomedical understanding of health and development efforts bolster this approach as they are often led by western organizations rooted in a colonial approach.

 Through a decolonized approach, implement an education and service delivery programme alongside communities in MENA to increase access to chronic pain physiotherapy treatment for persons impacted by trauma.

 From 2019, BPSS and TI treatment approaches and educational resources in English, Arabic, and Kurdish Sorani were developed and utilized in educational programmes and service delivery initiatives. These efforts centered a decolonized approach with the impact evaluated through learning outcomes, surveys, qualitative interviews, and a quantitative treatment outcome analysis.

 In MENA, 26 physiotherapists graduated from the Pain School educational programme with 8 Arabic and Kurdish Sorani speakers becoming certified trainers – resulting in 6 organizations providing the treatment to at least 200 persons impacted by trauma. Treatment outcomes are being analyzed. Additionally, in Iraq, 17 healthcare professionals became trainers in Beyond Pain (a multilingual BPPS pain resource) – resulting in 100 physiotherapists participating in trainings and an additional 100 persons around the world accessing the resource.

It is feasible to implement chronic pain education and treatment services alongside physiotherapists in MENA through a decolonized approach. However, systematic barriers prevent a liberated approach. 

November 30, 2022