Persistent or chronic pain currently effects one in five New Zealanders with the prevalence growing by 37 percent since 2006. Once entrenched persistent pain can be difficult to treat, despite the exponential growth of our understanding of pain science over recent decades.
The traditional approach to persistent or chronic pain is to conceptualise it as a symptom of injury or illness. This resulted in treatment that was focussed on addressing the underlying biomedical factors with the expectation that pain would then resolve. Evidence gathered over recent decades informs us that this is not the case, and that changes in the way the sensation of pain is mediated can result in pain persisting beyond the point where normal healing takes place.
How to Recognise the Risk Factors of Developing Persistent Pain
The ability to recognise risk factors that may increase the likelihood of developing chronic pain is critical. There are a number of specific factors that can be used to predict those who may progress to develop a persistent pain problem. These factors can be broadly categorised into psychosocial factors, lifestyle factors and behaviours or cognitions relating to pain.
Psychosocial and contextual factors including previous injury history, socioeconomic factors, employment satisfaction, number of pain sites, and beliefs and attitudes to pain. Importantly high levels of anxiety, stress response and depression are strongly correlated with the transition from acute to persistent pain. These factors influence the pain experience through direct physical processes.
Lifestyle factors such as poor sleep patterns and poor nutrition habits are both a risk factor and moderator of ongoing pain. Poor sleep will impact on recovery from injury and illness and also plays a significant role in the changes to occur in the body in the transition to persistent pain. It is also worth noting that up to 80 percent of individuals with chronic pain have ongoing sleep difficulties.
Behaviours and cognitions such as avoidance of activity due to fear of increased pain or re-injury, catastrophic thought processes including ruminating on the pain experience, magnifying its impact, and feeling helpless about the impact that pain is having are key risk factors of developing persistent pain.
The next post will look at how we can deal with the problem of persistent pain.