General understanding statements:
Seperation between acute pain and a chronic pain is an arbitrary one
Better to think of it as 'acute pain is consequence of injury - and chronic pain is persistent pain once the initial insult has healed'
Acute pain is generally useful - allows us to note the cause and move away from harm. However, it can be maladaptive - such as increased insomnia due to hypervigilence when experiencing pain - preventing appropriate sleep and recuperation.
Risk factors for chronic pain from acute pain:
Pre-operative:
Chronic pain before the operation, psychological vulnerabilities (including catastrophisation), female gender, younger age.
Post-operative:
Poorly controlled acute post-operative pain
Preventative factors for developing post-acute chronic pain:
Regional anaesthesia techniques, peri-operative pregabalin and gabapentin possibly.
Assessment of acute pain:
Need to consider both active and inactive levels of pain
Can use a Functional Activity Scale (A: No limitation, B: Mild limitation, C: Significant limitation)
Essential reading:
Schug SA, Palmer GM, Scott DA, Halliwell R, Trinca J. 2015. Acute pain management: scientific evidence (4th ed.). Melbourne: Faculty of Pain Medicine.
Schug SA, Scott DA, Mott JF, Halliwell R, Palmer GM, Alcock M; APM:SE Working Group of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine.
2020. Acute pain management: scientific evidence (5th ed.). Melbourne: ANZCA & FPM.
Macintyre PE, Loadsman JA, Scott DA. 2011. ‘Opioids, ventilation and acute pain management’. Anaesthesia and intensive care 39 (4): 545–58. EZ
Macintyre PE, Schug SA. 2015. Acute pain management: a practical guide (4th ed.). Boca Raton: CRC Press. NA
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