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We can predict rain but can’t yet predict chronic pain

Accurate weather forecasts allow us to prepare for rain, snow, and temperature changes. We can avoid driving on icy roads, pack an umbrella, or purchase sunblock, depending on what is predicted. Forecasting also generates information trustworthy enough to evacuate a city at risk from a category 4 hurricane. Meteorology has come a long way; today satellite data inform sophisticated computer weather models. Unfortunately, the same can’t be said for forecasting chronic pain. In most cases, health care providers can’t anticipate early or accurately enough which patients might develop long-lasting pain.

Does this come as a surprise to you? Surely people with the most severe injury are the same people to develop chronic pain, right? Not so much. Study after study shows this isn’t the case. Chronic pain can result from simple procedures or from minor injuries. Conversely, people can be completely pain-free after a severe accident or major surgery. This paradox is the reason why learning more about acute-to-chronic pain transitions is of such high priority for future research.

Articles recently published in Physical Therapy (PTJ) shed some light on the problem. The influence of fear, anxiety, depressive symptoms, and catastrophizing on pain has been well documented, but Linton et al share new theories on how these psychological factors interact to lead to chronic pain. They sharea fascinating observation: coping strategies that are helpful in the short term continue to be used even when, ironically, these very same strategies maintain the problem in the long term. Their article gives compelling theoretical information that will inspire updated measurement methods and encourage innovation in patient management.

Beneciuk et al investigated the development of persistent pain after seeking physical therapy. This study included measures across multiple domains to predict whether study participants met a standard criterion for having persistent pain at 12 months. These data confirm other research showing that higher levels of pain and pain-associated distress were predictors of persistent pain—but the findings also indicate that the number of other chronic health conditions and having symptoms in other body systems were predictive, too. These findings provide direction for additional research on how an individual’s overall health status may affect his or her vulnerability for developing chronic pain.

Image credit: Photo by American Physical Therapy Association. Used with permission.

Predicting chronic pain is a complex task, as highlighted by these articles in PTJ; and, as highlighted by an article in Pain Medicine, there is a role for epigenetics in understanding the transition to chronic pain. These and other articles indicate that future research will need to challenge existing paradigms before we will be able to effectively deliver personalized care for preventing the development of chronic pain. For many years, emphasis was placed on diagnostic testing. Research to date, however, clearly indicates that diagnosis alone does not determine whether chronic pain develops. Instead, it appears that improved prediction of the transition to chronic pain will come from considering a wide variety of factors.

Ongoing research will determine how a chronic pain forecast can be customized through the evaluation of factors such as variability in gene expression, individual pain sensitivity, psychological distress, presence of other health conditions, and socioeconomic status. When all these components are combined and verified to create an accurate forecast, that information could potentially be invaluable to the development of individualized pain management plans.

Knowing an individual’s chronic pain forecast might help avoid overutilization of higher-risk treatments. For example, a long-term forecast indicating that there is low likelihood of chronic low back pain would mean exercise is a better treatment option than opioids or surgery. This long-term forecast would be especially beneficial if the short-term responses to exercise are not favorable and if there is an option to escalate care to include opioids or surgery. An individual could choose to continue with the exercise treatment longer knowing that the back pain is not likely to become chronic.

Conversely, a long-term forecast indicating a high likelihood of chronic low back pain might trigger the delivery of interdisciplinary treatment. Typically, interdisciplinary treatment is an option used only after different individual treatments have failed. However, with individualized predictions, interdisciplinary treatment could be offered much earlier than currently usual, possibly improving the outcomes from this approach.

Accurate weather forecasting has saved countless lives by allowing adequate preparation for severe weather; accurate prediction of the transition to chronic pain will help better direct treatment that improves quality of life—and could even save lives by avoiding the perils of opioid addiction.

Featured image credit: Photo by American Physical Therapy Association. Used with permission.

Recent Comments

  1. Jane

    The first thing that must happen is that all pain must be taken seriously. “Suck it up and take two Bufferin” simply doesn’t cut it. If we’re going to understand how to prevent the chronification of pain, even mild pain must be addressed aggressively and expeditiously. There must be an effort to prevent pain from chronifying and that starts early on in the process.

  2. Roy Film

    Nice post, Steve! We know patients are much more likely to develop chronic pain by living in the US. So much of the literature has been looking at beliefs and attitudes of patients. It may be interesting to study the beliefs and attitudes of healthcare professionals and any correlation to the development of persistent pain in their patients. We are turning these people into chronic pain patients and we haven’t yet fully confronted the possibility that physical therapists may be indirectly and unwittingly complicit in the opioid epidemic. Always look forward to hearing your perspective.

  3. Keith

    Great commentary, Steve. Really looking forward to reading this special issue of PTJ. Love the idea I have seen from both Peter O’Sullivan and Chad Cook of a web/radar graph that plots the areas that may need emphasized on an individual basis. This brings us much closer to an individualized approach rather than a uni-dimensional classification based approach to pain management. And thanks for the great work you continue to do to bring PIP to our attention.

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