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Acute to Chronic Pain: Transition in the Postsurgical Patient

  • Jordan Garman
  • Christopher Paul
  • Roland Thomas ShortIII
Chapter

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.

Keywords

Chronic postsurgical pain Persistent postsurgical pain Peripheral sensitization Central sensitization Descending modulatory system Descending noxious inhibitory control system Biopsychosocial Neuropathic pain 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Jordan Garman
    • 1
  • Christopher Paul
    • 2
  • Roland Thomas ShortIII
    • 3
  1. 1.Columbia Pain and Spine InstituteGreshamUSA
  2. 2.Department of AnesthesiologyUniversity of Arkansas for Medical SciencesBirminghamUSA
  3. 3.The University of Alabama at BirminghamBirminghamUSA

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