Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Feb 5;22(2):9.
doi: 10.1007/s11916-018-0666-8.

Chronification of Pain: Mechanisms, Current Understanding, and Clinical Implications


Chronification of Pain: Mechanisms, Current Understanding, and Clinical Implications

Daniel J Pak et al. Curr Pain Headache Rep. .


Purpose of review: The development of acute to chronic pain involves distinct pathophysiological changes in the peripheral and central nervous systems. This article reviews the mechanisms, etiologies, and management of chronic pain syndromes with updates from recent findings in the literature.

Recent findings: Chronic post-surgical pain (CPSP) is not limited to major surgeries and can develop after smaller procedures such as hernia repairs. While nerve injury has traditionally been thought to be the culprit for CPSP, it is evident that nerve-sparing surgical techniques are not completely preventative. Regional analgesia and agents such as ketamine, gabapentinoids, and COX-2 inhibitors have also been found to decrease the risks of developing chronic pain to varying degrees. Yet, given the correlation of central sensitization with the development of chronic pain, it is reasonable to utilize aggressive multimodal analgesia whenever possible. Development of chronic pain is typically a result of peripheral and central sensitization, with CPSP being one of the most common presentations. Using minimally invasive surgical techniques may reduce the risk of CPSP. Regional anesthetic techniques and preemptive analgesia should also be utilized when appropriate to reduce the intensity and duration of acute post-operative pain, which has been correlated with higher incidences of chronic pain.

Keywords: Central sensitization; Chronic post-surgical pain; Hyperalgesia; Opioid; Peripheral sensitization; Preemptive analgesia.

Similar articles

See all similar articles

Cited by 3 articles


    1. Anesthesiology. 2010 Jun;112(6):1494-502 - PubMed
    1. Curr Med Res Opin. 2013 Sep;29(9):1127-35 - PubMed
    1. Nature. 1992 Jan 2;355(6355):75-8 - PubMed
    1. Proc Natl Acad Sci U S A. 2008 Jun 24;105(25):8784-9 - PubMed
    1. Pain Ther. 2017 Dec;6(2):129-141 - PubMed

LinkOut - more resources