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

SEPTEMBER 04, 2013
Katie Eder
Within each of those four perspectives, Clark highlighted significant risk factors — along with their appropriate targeted treatments — that may specifically cause the transition from acute pain to chronic pain. For example, one study found depressive disorders at baseline doubled a patient’s risk for new onset back pain 13 years later, so Clark said a patient who presents that disease should be prescribed antidepressants. Similarly, patients with substance use behaviors should take part in group-based behavioral psychotherapy, while those with a life story of pain catastrophizing — defined as the exaggeration of distress over an anticipated or actual painful experience — should join support groups and receive insight-oriented psychotherapy.
To help the physicians in the audience understand the effectiveness of his strategies, Clark presented a case study of a 45-year-old Korean woman whose foot was crushed by heavy equipment. After six months of poorly complying with physical therapy, experiencing high levels of acute pain, and taking short-acting opioids and acetaminophen with multiple agents for insomnia and anxiety, the patient decided to have her leg below the knee amputated by an orthopedic surgeon against Clark’s pleas not to amputate.

After the patient reluctantly agreed to see Clark throughout her post-operation period, she was prescribed 300-milligram sertraline for her major depressive disorder and 500-milligram BID valproate for her post-amputation pain. Additionally, the patient joined support groups to overcome fear and avoidance, received prosthetics and physical therapy to restore her pre-amputation physical state, and underwent occupational therapy to return to full-time work and become financially independent enough to divorce her cheating husband.
Although Clark said “not many people would think amputation in this case is a good idea,” he noted that his case study provides “hope for preventing chronic pain, since some might say she lost her leg and gained her life, and some might argue it was almost necessary for her to go through the leg amputation to get to this endpoint.”
Clark concluded that hope for preventing chronic pain across the entire acute pain patient population lies in recognizing the four profiles of risk, preventing the transition from acute to chronic pain, treating specific causes of new chronic pain, and addressing the nature of barriers to restoring health.

To learn more about chronic pain patients, watch this YouTube clip of Clark.

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