Current Pain and Headache Reports

, Volume 13, Issue 1, pp 7–11

Factors contributing to pain chronicity

  • Charlie K. Wang
  • Jennifer Myunghae Hah
  • Ian Carroll


The chronicity of pain is the feature of pain that is least understood and most directly linked with our inability to effectively manage pain. Acute pain is relatively responsive to our current pharmacologic and interventional armamentarium. However, as pain persists, our ability to treat effectively diminishes and the patient’s frustration and resource utilization increases. This article explores our current understanding of the factors linked to pain duration and the transition from acute to chronic pain in both human and animal models, and across a spectrum of human chronic pain conditions.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Pan ZZ, Williams JT, Osborne PB: Opioid actions on single nucleus raphe magnus neurons from rat and guinea-pig in vitro. J Physiol 1990, 427:519–532.PubMedGoogle Scholar
  2. 2.
    Heinricher MM, Morgan MM, Tortorici V, Fields HL: Disinhibition of off-cells and antinociception produced by an opioid action within the rostral ventromedial medulla. Neuroscience 1994, 63:279–288.PubMedCrossRefGoogle Scholar
  3. 3.
    Pertovaara A, Wei H, Hämäläinen MM: Lidocaine in the rostroventromedial medulla and the periaqueductal gray attenuates allodynia in neuropathic rats. Neurosci Lett 1996, 218:127–130.PubMedCrossRefGoogle Scholar
  4. 4.
    Kovelowski CJ, Ossipov MH, Sun H, et al.: Supraspinal cholecystokinin may drive tonic descending facilitation mechanisms to maintain neuropathic pain in the rat. Pain 2000, 87:265–273.PubMedCrossRefGoogle Scholar
  5. 5.
    Ossipov MH, Hong Sun T, Malan P, et al.: Mediation of spinal nerve injury induced tactile allodynia by descending facilitatory pathways in the dorsolateral funiculus in rats. Neurosci Lett 2000, 290:129–132.PubMedCrossRefGoogle Scholar
  6. 6.
    Porreca F, Burgess SE, Gardell LR, et al.: Inhibition of neuropathic pain by selective ablation of brainstem medullary cells expressing the mu-opioid receptor. J Neurosci 2001, 21:5281–5288.PubMedGoogle Scholar
  7. 7.
    Lin CS, Tsaur ML, Chen CC, et al.: Chronic intrathecal infusion of minocycline prevents the development of spinalnerve ligation-induced pain in rats. Reg Anesth Pain Med 2007, 32:209–216.PubMedCrossRefGoogle Scholar
  8. 8.
    Ledeboer A, Sloane EM, Milligan ED, et al.: Minocycline attenuates mechanical allodynia and proinflammatory cytokine expression in rat models of pain facilitation. Pain 2005, 115:71–83.PubMedCrossRefGoogle Scholar
  9. 9.
    McCracken LM, Gross RT: Does anxiety affect coping with chronic pain? Clin J Pain 1993, 9:253–259.PubMedGoogle Scholar
  10. 10.
    Vlaeyen JW, Kole-Snijders AM, Boeren RG, van Eek H: Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995, 62:363–372.PubMedCrossRefGoogle Scholar
  11. 11.
    Burton AK, Tillotson KM, Main CJ, Hollis S: Psychosocial predictors of outcome in acute and subchronic low back trouble. Spine 1995, 20:722–728.PubMedCrossRefGoogle Scholar
  12. 12.
    Swinkels-Meewisse IE, Roelofs J, Schouten EG, et al.: Fear of movement/(re)injury predicting chronic disabling low back pain: a prospective inception cohort study. Spine 2006, 31:658–664.PubMedCrossRefGoogle Scholar
  13. 13.
    Severeijns R, Vlaeyen JW, van den Hout MA, Picavet HS: Pain catastrophizing and consequences of musculoskeletal pain: a prospective study in the Dutch community. J Pain 2005, 6:125–132.PubMedCrossRefGoogle Scholar
  14. 14.
    McCracken LM, Gross RT, Sorg PJ, Edmands TA: Prediction of pain in patients with chronic low back pain: effects of inaccurate prediction and pain-related anxiety. Behav Res Ther 1993, 31:647–652.PubMedCrossRefGoogle Scholar
  15. 15.
    Ochsner KN, Ludlow DH, Knierim K, et al.: Neural correlates of individual differences in pain-related fear and anxiety. Pain 2006, 120:69–77.PubMedCrossRefGoogle Scholar
  16. 16.
    Katona C, Peveler R, Dowrick C, et al.: Pain symptoms in depression: definition and clinical significance. Clin Med 2005, 5:390–395.PubMedGoogle Scholar
  17. 17.
    Croft PR, Papageorgiou AC, Ferry S, et al.: Psychologic distress and low back pain. Evidence from a prospective study in the general population. Spine 1995, 20:2731–2737.PubMedCrossRefGoogle Scholar
  18. 18.
    Hotopf M, Mayou R, Wadsworth M, Wessely S: Temporal relationships between physical symptoms and psychiatric disorder. Results from a national birth cohort. Br J Psychiatry 1998, 173:255–261.PubMedCrossRefGoogle Scholar
  19. 19.
    Currie SR, Wang J: More data on major depression as an antecedent risk factor for first onset of chronic back pain. Psychol Med 2005, 35:1275–1282.PubMedCrossRefGoogle Scholar
  20. 20.
    Larson SL, Clark MR, Eaton WW: Depressive disorder as a long-term antecedent risk factor for incident back pain: a 13-year follow-up study from the Baltimore Epidemiological Catchment Area sample. Psychol Med 2004, 34:211–219.PubMedCrossRefGoogle Scholar
  21. 21.
    Carroll LJ, Cassidy JD, Côté P: Depression as a risk factor for onset of an episode of troublesome neck and low back pain. Pain 2004, 107:134–139.PubMedCrossRefGoogle Scholar
  22. 22.
    Von Korff M, Le Resche L, Dworkin SF: First onset of common pain symptoms: a prospective study of depression as a risk factor. Pain 1993, 55:251–258.CrossRefGoogle Scholar
  23. 23.
    Magni G, Moreschi C, Rigatti-Luchini S, Merskey H: Prospective study on the relationship between depressive symptoms and chronic musculoskeletal pain. Pain 1994, 56:289–297.PubMedCrossRefGoogle Scholar
  24. 24.
    Dworkin RH, Clark WC, Lipsitz JD: Pain responsivity in major depression and bipolar disorder. Psychiatry Res 1995, 56:173–181.PubMedCrossRefGoogle Scholar
  25. 25.
    Brander VA, Stulberg SD, Adams AD, et al.: Predicting total knee replacement pain: a prospective, observational study. Clin Orthop Relat Res 2003, 416:27–36.PubMedCrossRefGoogle Scholar
  26. 26.
    Haythornthwaite JA, Raja SN, Fisher B, et al.: Pain and quality of life following radical retropubic prostatectomy. J Urol 1998, 160:1761.PubMedCrossRefGoogle Scholar
  27. 27.
    Pluijms WA, Steegers MAH, Verhagen AFTM, et al.: Chronic post-thoracotomy pain: a retrospective study. Acta Anaesthesiol Scand 2006, 50:804–808.PubMedCrossRefGoogle Scholar
  28. 28.
    Matsunaga M, Dan K, Manable FY, et al.: Residual pain of 90 thoracotomy patients with malignancy and non-malignancy. Pain 1990, 5(Suppl):S148.CrossRefGoogle Scholar
  29. 29.
    Gotoda Y, Kambara N, Sakai T, et al.: The morbidity, time course and predictive factors for persistent post-thoracotomy pain. Eur J Pain 2001, 5:89.PubMedCrossRefGoogle Scholar
  30. 30.
    Ochroch EA, Gottschalk A, Troxel AB, Farrar JT: Women suffer more short and long-term pain than men after major thoracotomy. Clin J Pain 2006, 22:491.PubMedCrossRefGoogle Scholar
  31. 31.
    Paulson PE, Minoshima S, Morrow TJ, Casey KL: Gender differences in pain perception and patterns of cerebral activation during noxious heat stimulation in humans. Pain 1998, 76:223.PubMedCrossRefGoogle Scholar
  32. 32.
    Chia YY, Chow LH, Hung CC, et al.: Gender and pain upon movement are associated with the requirements for postoperative patient-controlled iv analgesia: a prospective survey of 2,298 Chinese patients. Can J Anaesth 2002, 49:249.PubMedGoogle Scholar
  33. 33.
    Bachiocco V, Morselli-Labate AM, Rusticali AG, et al.: Intensity, latency and duration of post-thoracotomy pain: relationship to personality traits. Funct Neurol 1990, 5:321–332.PubMedGoogle Scholar
  34. 34.
    Aasvang EK, Brandsborg B, Christensen B, et al.: Neurophysiological characterization of postherniotomy pain. Pain 2008, 137:173–181.PubMedCrossRefGoogle Scholar
  35. 35.
    Mikkelsen T, Werner MU, Lassen B, Kehlet H: Pain and sensory dysfunction 6 to 12 months after inguinal herniotomy. Anesth Analg 2004, 99:146–151.PubMedCrossRefGoogle Scholar
  36. 36.
    Angst MS, Koppert W, Pahl I, et al.: Short-term infusion of the mu-opioid agonist remifentanil in humans causes hyperalgesia during withdrawal. Pain 2003, 106:49–57.PubMedCrossRefGoogle Scholar
  37. 37.
    Chia YY, Liu K, Wang JJ, et al.: Intraoperative high dose fentanyl induces postoperative fentanyl tolerance. Can J Anaesth 1999, 46:872–877.PubMedCrossRefGoogle Scholar
  38. 38.
    Webster BS, Verma SK, Gatchel RJ: Relationship between early opioid prescribing for acute occupational low back pain and disability duration, medical costs, subsequent surgery and late opioid use. Spine 2007, 32:2127–2132.PubMedCrossRefGoogle Scholar
  39. 39.
    Whitley RJ, Shukla S, Crooks RJ: The identification of risk factors associated with persistent pain following herpes zoster. J Infect Dis 1998, 178(Suppl 1):S71–S75.PubMedCrossRefGoogle Scholar
  40. 40.
    Huff JC, Drucker JL, Clemmer A, et al.: Effect of oral acyclovir on pain resolution in herpes zoster: a reanalysis. J Med Virol 1993, Suppl 1:93–96.Google Scholar
  41. 41.
    Tyring S, Barbarash RA, Nahlik JE, et al.: Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia. A randomized, double-blind, placebo-controlled trial. Collaborative Famciclovir Herpes Zoster Study Group. Ann Intern Med 1995, 123:89–96.PubMedGoogle Scholar
  42. 42.
    Tyring SK, Beutner KR, Tucker BA, et al.: Antiviral therapy for herpes zoster: randomized, controlled clinical trial of valacyclovir and famciclovir therapy in immunocompetent patients 50 years and older. Arch Fam Med 2000, 9:863–869.PubMedCrossRefGoogle Scholar
  43. 43.
    Manabe H, Dan K, Higa K: Continuous epidural infusion of local anesthetics and shorter duration of acute zosterassociated pain. Clin J Pain 1995, 11:220–228.PubMedGoogle Scholar
  44. 44.
    Manabe H, Dan K, Hirata K, et al.: Optimum pain relief with continuous epidural infusion of local anesthetics shortens the duration of zoster-associated pain. Clin J Pain 2004, 20:302–308.PubMedCrossRefGoogle Scholar
  45. 45.
    Dworkin RH, Portenoy RK: Pain and its persistence in herpes zoster. Pain 1996, 67:241–251.PubMedCrossRefGoogle Scholar
  46. 46.
    Dworkin RH, Hartstein G, Rosner HL, et al.: A high-risk method for studying psychosocial antecedents of chronic pain: the prospective investigation of herpes zoster. J Abnorm Psychol 1992, 101:200–205.PubMedCrossRefGoogle Scholar
  47. 47.
    Pasqualucci A, Pasqualucci V, Galla F, et al.: Prevention of post-herpetic neuralgia: acyclovir and prednisolone versus epidural local anesthetic and methylprednisolone. Acta Anaesthesiol Scand 2000, 44:910–918.PubMedCrossRefGoogle Scholar
  48. 48.
    De Kock M, Lavand’homme P, Waterloos H: The shortlasting analgesia and long-term antihyperalgesic effect of intrathecal clonidine in patients undergoing colonic surgery. Anesth Analg 2005, 101:566–572 (table of contents).PubMedCrossRefGoogle Scholar
  49. 49.
    Lavand’homme P, De Kock M, Waterloos H: Intraoperative epidural analgesia combined with ketamine provides effective preventive analgesia in patients undergoing major digestive surgery. Anesthesiology 2005, 103:813–820.PubMedCrossRefGoogle Scholar
  50. 50.
    Senturk M, Ozcan PE, Talu GK, et al.: The effects of three different analgesia techniques on long-term postthoracotomy pain. Anesth Analg 2002, 94:11–15 (table of contents).PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2009

Authors and Affiliations

  • Charlie K. Wang
  • Jennifer Myunghae Hah
  • Ian Carroll
    • 1
  1. 1.Stanford University School of MedicineStanfordUSA

Personalised recommendations