Introduction to the transition from acute to chronic pain

Chronic pain (pain that persists or recurs longer than 3 months) can develop following acute pain due to an acute illness, injury or trauma (eg shingles infection, surgery, whiplash).

The transition from acute to chronic pain is a complex, multifactorial process. While a significant proportion of chronic pain precipitated by an acute pain episode have a neuropathic component due to nerve injury, chronic inflammatory processes and central sensitisation may also contribute.

Neuropathic pain and central sensitisation are mediated by neurophysiological processes that increase excitability and decrease inhibitory inputs. Some of these processes may be targets for drug intervention (eg local anaesthetics, gabapentinoids, ketamine, tricyclic antidepressants, serotonin and noradrenaline reuptake inhibitors).

The ability to predict those patients who are likely to transition from acute to chronic pain following injury may allow early intervention and triage into chronic pain management services. Some risk factors have been identified, as well as preventive strategies; however, evidence is limited. Following acute illness, injury or trauma, consider seeking specialist advice if a patient has multiple risk factors for transitioning to chronic pain, or is taking high doses of opioids.