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Risk factors for development of chronic pain

Risk factors for development of chronic pain
  • Biologic: severity and extent of surgery, trauma[1] or disease condition (eg, poly-trauma, including burns), persistent cancer-related pain[2], genetic factors[3] including sickle cell disease[4], recurrent bouts of autoimmune inflammatory disease[5], metabolic disorders (eg diabetes), advanced age[6] and frailty.
  • Psychological: pre-existing mental health issues[7] (eg, poorly controlled depression, anxiety, catastrophizing, PTSD.)
  • Substance use or abuse (includes: tobacco, alcohol, sedatives, opioids[8])
  • Social: disabled, disconnection[9], loneliness[9], unstable housing, poverty, low health literacy, poor access to medical and behavioral care
  • Repeated surgeries[10] or ineffective procedures intended to relieve the same pain condition
  • Unintended and/or prolonged exposure to opioid analgesics[11]
  • Pre-existing wide-spread pain (eg, fibromyalgia[12])
Identification and treatment of risk factors may reduce the likelihood of patients transitioning from acute to chronic pain. For further information, refer to UpToDate content on evaluation of chronic non-cancer pain.
References:
  1. Chapman CR, Vierck CJ. The Transition of Acute Postoperative Pain to Chronic Pain: An Integrative Overview of Research on Mechanisms. J Pain 2017; 18:359.
  2. Kucyi A, Davis KD. The dynamic pain connectome. Trends Neurosci 2015; 38:86.
  3. Syx D, De Wandele I, Rombaut L, Malfait F. Hypermobility, the Ehlers-Danlos syndromes and chronic pain. Clin Exp Rheumatol 2017; 35 Suppl 107:116.
  4. Darbari DS, Ballas SK, Clauw DJ. Thinking beyond sickling to better understand pain in sickle cell disease. Eur J Haematol 2014; 93:89.
  5. Meeus M, Vervisch S, De Clerck LS, et al. Central sensitization in patients with rheumatoid arthritis: a systematic literature review. Semin Arthritis Rheum 2012; 41:556.
  6. Jones MR, Ehrhardt KP, Ripoll JG, et al. Pain in the Elderly. Curr Pain Headache Rep 2016; 20:23.
  7. Turk DC, Okifuji A. Psychological factors in chronic pain: evolution and revolution. J Consult Clin Psychol 2002; 70:678.
  8. Martel MO, Shir Y, Ware MA. Substance-related disorders: A review of prevalence and correlates among patients with chronic pain. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:245.
  9. Wolf LD, Davis MC, Yeung EW, Tennen HA. The within-day relation between lonely episodes and subsequent clinical pain in individuals with fibromyalgia: Mediating role of pain cognitions. J Psychosom Res 2015; 79:202.
  10. Hoofwijk DM, Fiddelers AA, Peters ML, et al. Prevalence and Predictive Factors of Chronic Postsurgical Pain and Poor Global Recovery 1 Year After Outpatient Surgery. Clin J Pain 2015; 31:1017.
  11. Hooten WM, Brummett CM, Sullivan MD, et al. A Conceptual Framework for Understanding Unintended Prolonged Opioid Use. Mayo Clin Proc 2017; 92:1822.
  12. Brummett CM, Urquhart AG, Hassett AL, et al. Characteristics of fibromyalgia independently predict poorer long-term analgesic outcomes following total knee and hip arthroplasty. Arthritis Rheumatol 2015; 67:1386.
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