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Acute to Chronic Pain: Transition in the Postsurgical Patient

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Abstract

The thread common to chronic pain of any type is that at one time it was acute. However, the transition period is so difficult to discern that most patients are unable to recall it. In fact, many patients with chronic pain cannot provide an exact inciting event or time of onset. The surgical encounter offers a unique vantage point for the clinician in that the onset of acute pain is an exact time point that can be documented and followed. Furthermore, depending on the type of surgery, a significant number of patients develop chronic pain. Therefore, such chronic postsurgical pain (CPSP) provides a means to investigate the more general question of how pain transitions from the acute to the chronic state. After surgery peripheral sensitization, central sensitization, and peripheral nerve injury induce a state of hypersensitivity in and around the primary site of injury. In most patients, as tissue heals, this hypersensitive state resolves until finally it returns to baseline. Contrarily, those patients who go on to develop CPSP maintain their hypersensitive state and often even amplify it, so that the pain spreads and worsens in severity. The reasons as to why only some patients progress toward CPSP are still not fully understood, but it is generally accepted that CPSP is a biopsychosocial phenomenon. The goal of this chapter is to outline the current understanding of how acute pain transitions into chronic pain using CPSP as a model.

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Authors and Affiliations

  1. Columbia Pain and Spine Institute, Gresham, OR, USA

    Jordan Garman DO

  2. Department of Anesthesiology, University of Arkansas for Medical Sciences, Birmingham, AL, USA

    Christopher Paul MD

  3. The University of Alabama at Birmingham, Birmingham, AL, USA

    Roland Thomas Short III MD

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    Rhonda J. Moore

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Garman, J., Paul, C., Short, R.T. (2018). Acute to Chronic Pain: Transition in the Postsurgical Patient. In: Moore, R. (eds) Handbook of Pain and Palliative Care. Springer, Cham. https://doi.org/10.1007/978-3-319-95369-4_16

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