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Classification
Of Pain

What Is Pain Chronification?

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Pain chronification describes the process of transient pain progressing into persistent pain; pain processing changes as a result of an imbalance between pain amplification and pain inhibition; genetic, environmental and biopsychosocial factors determine the risk, the degree, and time-course of chronification.1

 

Chronification simply refers to the gradual transition of acute pain to chronic pain. There are gradual modifications in the anatomical and physiological architecture of the pain pathways. It involves pathophysiological changes in pain processing that result in sensitisation, which plays a critical role in the development of chronic pain. Sensitisation is characterized by a decreased pain threshold, together with heightened and exaggerated responses to noxious stimuli.2

 

Chronic pain may involve irreversible pathophysiologic changes in the nervous system, so interrupting the cascade of events that allows acute pain to advance to chronic pain is of crucial importance and should be the goal in prompt intervention.4

Biopsychosocial model of pain

The biopsychosocial model postulates pain and disability as multidimensional, dynamic interactions among biological, psychological, and social factors that reciprocally influence each other (figure 1). It is generally accepted that characteristics such as depression, anxiety, poor sleep, and adverse social conditions can be the result of chronic pain, but it is less commonly known that these factors also predispose individuals to chronic pain. 3

nociception
  • Social expectations
  • Past pain experiences
  • Financial barriers or health insurance
  • Job satisfaction
  • Substance abuse
  • Social support system
  • Language and cultural barriers
Pain Chronification effects
effect1

Deconditioning
Biomedical problems
Loss of grey matter
Altered nociceptive pathways
Medication use or abuse

effect2

Depression
Cognitive impairment
Learned helplessness
Anxiety
Poor concentration

Social withdrawal
Dysfunctional relationships
Isolation
Increased suicide risk

Elaborated from figure 1 of ref. 3. Biopsychosocial model of pain showing the complex interaction between chronic pain and biological, psychological, and social factors

Chronic pain may involve irreversible pathophysiologic changes in the nervous system, so interrupting the cascade of events that allows acute pain to advance to chronic pain is of crucial importance and should be the goal in prompt intervention.4

pain 2
MC-I305-09-2024
Data preparation: January 2024

  1. Butler SH. Scand J Pain (2023); 23(2): 419–423
  2. Isa AS and Chetty S. Southern African Journal of Anaesthesia and Analgesia. 2022;28(1):11-14
  3. Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. Lancet. 2021 May 29;397(10289):2082-2097. doi: 10.1016/S0140-6736(21)00393-7. PMID: 34062143
  4. Pergolizzi JV et al. Pain Management Nursing (2014); 15(1): 380-390

Related contents:

What Is Acute Pain?

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What Is Chronic Pain?

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