Traumatised refugees: Refugee status--a yellow flag in managing back pain

doi:10.1136/bmj.39086.911065.1F

BMJ 2007;334:58 (13 January), doi:10.1136/bmj.39086.911065.1F

Letters

Traumatised refugees

Refugee status—a yellow flag in managing back pain

The first 150 words of the full text of this article appear below.

The migration of refugees from central Londonto the outer London suburbs exposes clinicians to the problemsof refugees that they may have no experience of, or trainingin. The recent discussion on bmj.com following the editorialby Basoglu presupposes that an appreciation that torture hastaken place is understood in primary care and the details madeavailable in any referral to the secondary sector.¹ ² We have recently reported that only 50% of referralletters to a rheumatology service for refugees complaining ofback or neck pain had this information provided.³ Consequentlya small number were "triaged" to the physiotherapy service,where, after unsuccessful standard back treatment, they werereferred on to the rheumatology service.

As a physician, I would not be so bold as tocomment on the diagnosis of post-traumatic stress disorder (PTSD),but when the sleep history clearly identifies nightmares regularlydisturbing sleep,⁴ the need for tricyclic . . . [Full text of this article]

Andrew O Frank, consultant physician in rehabilitation medicine and rheumatology

¹ Arthritis Centre, Northwick Park Hospital, Harrow, HA1 3UJ andrew.frank1@btinternet.com