How do we prevent the progression of acute to chronic pain?

Chronic musculoskeletal pain and subsequent disability is an increasing problem in the Western world. A recent update published in “Medical Observer” embraces the biopsychosocial model of pain as it allows practitioners to focus on potentially changeable factors, including emotions, illness behaviour and cognitions.

The International Society for the Study of Pain (ISAP) defines pain as “an unpleasant sensory and emotional experience associated with actual or potential damage or described in terms of such damage.” As such, pain is an entirely subjective matter and as a result is dependent on a number of factors including one’s psychological state, past experiences and socio-cultural environment.Whilst acute pain serves a biological function of warning one of impending tissue damage, chronic pain serves no useful function. In fact, it usually persists long after tissue damage has disappeared. Potential sequelae of chronic pain can be physiological (i.e. sleep disturbance, appetite changes, sexual dysfunction), psychological (i.e. anxiety, depression), behavioural (i.e. fear avoidance) and social (i.e. disturbed relationships, isolation).Many factors contribute to the progression of acute pain to chronic pain and the practitioner must be aware of these. These factors are not physical factors but rather psychosocial factors and factors in the work environment. Hence the biopsychosocial framework is the best approach when dealing with pain.Chronic pain should not be treated as ongoing acute pain as this may lead to iatrogenic disability and learned helplessness. Rather, chronic pain should be managed with thorough assessment and a focus on remediable factors. The patient should be encouraged to return promptly to normal activities and work practices. This model has been shown to decrease sick leave and disability in workers.When assessing a patient it is important to be aware of so-called “red” and “yellow flags.” Red flags are the alerting symptoms and signs that indicate the possibility of serious disease, whereas yellow flags are those alerting symptoms and signs of psychosocial distress that may lead to chronicity if not properly addressed.In terms of management, methods that have been shown to be beneficial include educating and assuring the patient, encouraging the patient to continue withn their usual activities, minimising analgesia and providing regular follow-up for patients with ongoing concerns.(Source: Medical Observer 23 January 2004, pages 20-21)