Chronification of Pain: Mechanisms, Current Understanding, and Clinical Implications

  • Daniel J. Pak
  • R. Jason Yong
  • Alan David Kaye
  • Richard D. UrmanEmail author
Other Pain (A Kaye and N Vadivelu, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Other Pain


Purpose of Review

The development of acute to chronic pain involves distinct pathophysiological changes in the peripheral and central nervous systems. This article reviews the mechanisms, etiologies, and management of chronic pain syndromes with updates from recent findings in the literature.

Recent Findings

Chronic post-surgical pain (CPSP) is not limited to major surgeries and can develop after smaller procedures such as hernia repairs. While nerve injury has traditionally been thought to be the culprit for CPSP, it is evident that nerve-sparing surgical techniques are not completely preventative. Regional analgesia and agents such as ketamine, gabapentinoids, and COX-2 inhibitors have also been found to decrease the risks of developing chronic pain to varying degrees. Yet, given the correlation of central sensitization with the development of chronic pain, it is reasonable to utilize aggressive multimodal analgesia whenever possible.


Development of chronic pain is typically a result of peripheral and central sensitization, with CPSP being one of the most common presentations. Using minimally invasive surgical techniques may reduce the risk of CPSP. Regional anesthetic techniques and preemptive analgesia should also be utilized when appropriate to reduce the intensity and duration of acute post-operative pain, which has been correlated with higher incidences of chronic pain.


Hyperalgesia Central sensitization Peripheral sensitization Chronic post-surgical pain Preemptive analgesia Opioid 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Daniel J. Pak
    • 1
  • R. Jason Yong
    • 1
  • Alan David Kaye
    • 2
  • Richard D. Urman
    • 1
    Email author
  1. 1.Department of Anesthesiology, Perioperative and Pain MedicineBrigham and Women’s HospitalBostonUSA
  2. 2.Department of Anesthesiology, School of MedicineLouisiana State UniversityNew OrleansUSA

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