Chronic pain following an injury is a significant concern in both medical and rehabilitation settings. Defined as pain persisting for more than three months beyond the usual course of an acute injury, chronic pain can severely impact an individual’s quality of life, mental health, and functional abilities 1. Understanding the risk factors that contribute to the development of chronic pain after an injury is crucial for early identification, prevention, and management.
A strong predictor of chronic pain is the extent of the initial injury. Severe injuries, particularly those involving significant tissue damage or nerve injury, are more likely to result in persistent pain. Injuries to weight-bearing joints like the knee or spine are particularly prone to long-term pain 1,2.
Genetic factors play a role in the perception and modulation of pain. Variations in genes related to pain sensitivity and inflammatory responses can predispose individuals to chronic pain. Family history of chronic pain conditions may also indicate a higher risk 3.
Individuals with pre-existing health conditions, such as arthritis, diabetes, or fibromyalgia, may also have an increased risk of developing chronic pain after an injury. These conditions can exacerbate pain responses and complicate recovery 4.
Older adults are more likely to experience chronic pain due to a slower healing process, pre-existing degenerative changes, and a higher prevalence of comorbid conditions. Additionally, women are more likely to develop chronic pain compared to men, potentially due to hormonal differences, pain sensitivity, and psychosocial factors 5,6.
A number of psychological factors can affect the risk of developing chronic pain after injury 1. Psychological conditions such as depression, anxiety, and post-traumatic stress disorder (PTSD) are significant risk factors for chronic pain, as they can amplify pain perception, reduce coping mechanisms, and hinder recovery. Furthermore, pain catastrophizing, characterized by an exaggerated negative orientation towards pain, is a strong predictor of chronic pain. Individuals who ruminate on pain, feel helpless, or expect the worst outcomes are more likely to experience persistent pain. Finally, high levels of stress and poor coping strategies can impede the healing process and increase the risk of chronic pain, making effective stress management and adaptive coping techniques essential for recovery 7–11.
An individual’s broader environment influences their risk for chronic pain as well. Lower socioeconomic status is associated with increased risk of chronic pain due to limited access to healthcare, resources, and support systems. Similarly, financial stress can also exacerbate pain and hinder effective pain management 12,13. Occupations involving repetitive motions, heavy lifting, or prolonged periods of sitting or standing can contribute to chronic pain development. Relatedly, job dissatisfaction and lack of support at work can negatively impact recovery 14,15. Lastly, social isolation and absent emotional support from family, friends, and community can exacerbate pain perception and reduce motivation for recovery 16.
Chronic pain after injury is a multifactorial phenomenon influenced by a combination of biological, psychological, and social factors. However, additional research is necessary to better identify and predict risk factors linked to post-injury chronic pain in a wide variety of patient populations 17.
References
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2. Causes of Chronic Pain. Available at: https://www.healthline.com/health/chronic-pain. (Accessed: 27th June 2024)
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10. Armstrong, A. D., Hassenbein, S. E., Black, S. & Hollenbeak, C. S. Risk Factors for Increased Postoperative Pain and Recommended Orderset for Postoperative Analgesic Usage. Clin. J. Pain (2020). doi:10.1097/AJP.0000000000000876
11. Daoust, R. et al. Early Factors Associated with the Development of Chronic Pain in Trauma Patients. Pain Res. Manag. (2018). doi:10.1155/2018/7203218
12. Yu, T. et al. The association between the socioeconomic status and body pain: A nationwide survey. Med. (United States) (2020). doi:10.1097/MD.0000000000019454
13. De Oliveira, A. M. B. et al. Socioeconomic and sex inequalities in chronic pain: A population-based cross-sectional study. PLoS One (2023). doi:10.1371/journal.pone.0285975
14. Yamada, K., Matsudaira, K., Imano, H., Kitamura, A. & Iso, H. Influence of work-related psychosocial factors on the prevalence of chronic pain and quality of life in patients with chronic pain. BMJ Open (2016). doi:10.1136/bmjopen-2015-010356
15. The Epidemiology of Chronic Pain and Work Disability – Pain and Disability – NCBI Bookshelf. Available at: https://www.ncbi.nlm.nih.gov/books/NBK219253/. (Accessed: 2nd July 2024)
16. Franqueiro, A. R., Yoon, J., Crago, M. A., Curiel, M. & Wilson, J. M. The Interconnection Between Social Support and Emotional Distress Among Individuals with Chronic Pain: A Narrative Review. Psychology Research and Behavior Management (2023). doi:10.2147/PRBM.S410606
17. Alkassabi, O. et al. Risk Factors to Persistent Pain Following Musculoskeletal Injuries: A Systematic Literature Review. International Journal of Environmental Research and Public Health (2022). doi:10.3390/ijerph19159318