Common Biological Modulators of Acute Pain: An Overview Within the AAAPT Project (ACTTION-APS-AAPM Acute Pain Taxonomy)

Pain Med. 2020 Oct 1;21(10):2394-2400. doi: 10.1093/pm/pnaa207.


Objective: The ACTTION-APS-AAPM Acute Pain Taxonomy (AAAPT) project relies on the identification of modulators to improve characterization and classification of acute pain conditions. In the frame of the AAAPT effort, this paper presents an overview of common biological modulators of acute pain.

Methods: Nonsystematic overview.

Results: Females may experience more acute pain than males, but the clinical significance may be modest. Increasing age is associated with decreasing analgesic requirement and decreasing pain intensity after surgery and with higher risk of acute low back pain. Racial and ethnic minorities have worse pain, function, and perceived well-being. Patients with preexisting chronic pain and opioid use are at higher risk of severe acute pain and high opioid consumption. The OPRM1 gene A118G polymorphism is associated with pain severity and opioid consumption, with modest quantitative impact. Most studies have found positive associations between pain sensitivity and intensity of acute clinical pain. However, the strength of the association is unclear. Surgical techniques, approaches, and complications influence postoperative pain.

Conclusions: Sex, age, race, ethnicity, preexisting chronic pain and opioid use, surgical approaches, genetic factors, and pain sensitivity are biological modulators of acute pain. Large studies with multisite replication will quantify accurately the association between modulators and acute pain and establish the value of modulators for characterization and classification of acute pain conditions, as well as their ability to identify patients at risk of uncontrolled pain. The development and validation of quick, bed-side pain sensitivity tests would allow their implementation as clinical screening tools. Acute nonsurgical pain requires more investigation.

Keywords: Acute Pain; Assessment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Pain* / drug therapy
  • Analgesics, Opioid / therapeutic use
  • Chronic Pain* / drug therapy
  • Female
  • Humans
  • Male
  • Pain Measurement
  • Pain, Postoperative / drug therapy
  • Pain, Postoperative / genetics
  • Receptors, Opioid, mu


  • Analgesics, Opioid
  • Receptors, Opioid, mu