Hope for Preventing Transition from Acute Pain to Chronic Pain Lies in New Risk Profiles

SEPTEMBER 04, 2013
Katie Eder
The standard definition of chronic pain includes a pain severity score above 6 out of 10, duration of pain for longer than three months, and impairments in function and quality of life associated with pain severity and duration. But in his presentation at PAINWeek 2013, Michael R. Clark, MD, MPH, MBA, director of the Chronic Pain Treatment Program at Johns Hopkins Medicine, noted that description doesn’t inform physicians about how chronic pain develops, or why one patient who experiences acute pain crosses into chronic territory while another patient doesn’t.
Instead of rewriting the definition of chronic pain in his “When Does Acute Pain Become Chronic?” session, Clark outlined the vulnerabilities that put patients with acute pain at risk of transitioning into new chronic pain, and then discussed how rational treatment approaches addressing those patient-centered risk factors can prevent that transformation.
Noting that the typical risk factors of demographic variables, pain characteristics, psychological factors, and contextual details provide “no recipe for, ‘Okay, what do you do about these things?’ ” Clark offered a new chronic pain cases formulation that includes four profiles of risk, which are:
  • Diseases: Search for all possible broken parts causing pathology and select treatments that will minimize new damage and subsequent pathology
  • Dimensions: Recognize how much of each individual trait a patient possesses, and then match the strengths of each trait with specific tasks to optimize the patient’s capabilities
  • Behaviors: Point out problematic behaviors every time they occur, but also emphasize and reinforce productive behaviors whenever possible
  • Life Stories: Expand medical history to include every aspect of the patient’s life and help the patient find an answer to the question, “What good does life, hold for me?”

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