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Defining Chronic Pain

Chronic pain can mean many things to many different people. Often, pain is termed chronic when it has reached a certain duration of time, such as three or six months. A group in the United States has attempted to develop a newer way of defining chronic pain that includes risk assessment and prognosis. The authors of the study then sought to see if this approach could be used in the United Kingdom.

The prediction as to whether pain will become chronic is felt to include psychosocial risk factors, distress, and preoccupation with body symptoms. These are also known as yellow flags. This newer approach predicts the probability of pain becoming chronic and significant in terms of disability. This allows for the identification of patients that would benefit from psychological and behavioral interventions. Being pain free is not always the goal, but having less pain severity and disability are desired goals.

In the UK study, 426 adults, age 30 to 59 years old were given questionnaires that assessed severity of pain, impact in daily life, pain duration, the presence of pain elsewhere than the back, and depression. These same areas were assessed in the original US study.

Risk was categorized as low, intermediate, possible chronic pain, and probable chronic pain. There were some differences found in the risk score groups between the US sample and the UK sample. Six percent of subjects in the US study were classified as being in the probable chronic back pain category. In the UK study, twenty-two percent of the sample were in this category. While thirty one percent of the US sample population were in the low risk category, eleven percent of the UK sample were in this category. This difference was not felt to be due to methods used, or sampling techniques.

While results were different among the two studies, the authors felt that this assessment approach that allows for prognosis of chronic pain is useful, and is generalisable to other similar populations other than in the US. This approach is thought to be especially reliable for the classification of people at high risk of having clinically significant back pain.

References: Dunn, K.M. et al. A prognostic approach to defining chronic pain: Replication in a UK primary care low back pain population. PAIN 2008. Vol. 135. Pp. 48-54.

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