Risk factors for the transition from acute to chronic pain

It is unclear why chronic pain occurs in some patients after an acute illness, injury or trauma but not in others; however, a number of risk factors for transition from acute to chronic pain have been suggested (see Risk factors associated with the transition from acute to chronic pain ). Psychological factors (especially catastrophising) and the severity of acute pain are of particular relevance.

Table 1. Risk factors associated with the transition from acute to chronic pain
[NB1] [NB2]
Category	Risk factor
patient characteristics and comorbidities	female low socioeconomic status low educational attainment younger age (adults) receiving compensation for a work-related injury or illness genetic predisposition disability severe or numerous comorbidities postoperative chemotherapy
psychological	anxiety catastrophising depression psychological vulnerability stress low self-efficacy poor coping skills
pain	pre-existing pain condition associated with [NB3]: chronic pain regular opioid use sensitisation (eg hyperalgesia) acute postoperative pain that is: neuropathic associated with secondary hyperalgesia severe [NB4]
surgical technique	longer duration of surgery nerve injury traumatic approaches (eg open versus laparoscopic) type of surgery need for repeated revisions radiotherapy to surgical area
Note: NB1: Although many of these risk factors have been identified in chronic postsurgical pain, it is likely that they are relevant to other conditions that transition from acute to chronic pain. NB2: Some risk factors may be modifiable; see Modifiable risk factors for preventing chronic postsurgical pain. NB3: Pre-existing pain is not necessarily related to the site of current acute pain. NB4: Severe acute pain is one of the strongest predictors of chronic pain.