Acute to chronic pain transition in extremity trauma: A narrative review for future preventive interventions (part 2)

Abstract

Background: The first part of this series of 2 articles revealed that chronic pain is an important issue post extremity trauma (ET) involving permanent biological transformations. Interventions aimed at preventing chronic pain in ET patients are therefore required.

Objective: To conduct a comprehensive analysis of literature on risk and protective factors for chronic pain post-ET to guide the development of relevant preventive interventions.

Methods: A narrative review of the literature was undertaken. Databases were searched to identify studies on chronic pain prognostic factors in ET patients.

Results: Demographic, injury-related and psychological factors were shown to either contribute to or limit acute to chronic pain transition. High-intensity acute pain hasconsistently been identified as an important chronic pain risk factor. Other significant documented risk factors include: female gender, older age, less than college education, lower limb injury, symptoms of anxiety and depression and pain catastrophizing. Pain self-efficacy and pain acceptance have been shown to protect individuals against chronic pain.

Conclusions: This narrative review highlights factors placing ET patients at higher risk of chronic pain or protecting them against this problem. Determining how these factors could be addressed in preventive interventions is the next step before undertaking their development.

Keywords: Acute pain; Acute to chronic pain transition; Chronic pain; Extremity trauma; Limb injury; Prognostic factors; Protective factors; Risk factors.