In the last post we raised the issue of defining chronic pain. One suggestion was to define it in terms of duration. Van Korff & Dunn, in Chronic Pain Reconsidered (2008), argue that “while conceptually appealing, this approach has not produced reliable or valid methods for differentiating acute from chronic pain for clinical or epidemiological research, nor has it led to practical operational criteria for identifying chronic pain in clinical practice. Defining chronic pain solely by duration does not indicate whether long-lasting pain is clinically significant, and duration-based definitions can be difficult to apply to recurrent pain.”
For these reasons, re-examine the definition of chronic pain, arguing: “the term chronic pain is as much a prognostic statement as a description of pain history. “(2008) Von Korff and Miglioretti recently proposed defining chronic back pain prospectively, using a Risk Score to predict the likelihood that clinically significant pain is present at a future time. The Risk Score approach suggests that chronic pain should be defined by the likelihood that clinically significant pain will continue in the future, not only by how long pain has lasted.
Many factors contribute to the state of chronicity. Furthermore, the word “chronic” implies an unchanging condition, which “chronic pain” is not. Furthermore, predicting whether pain will run a chronic course is not simply a matter of determining its duration. A patient who limits activities and reports depressive symptoms and pain at diffuse anatomical locations may fit a clinician’s intuitive chronic pain profile better than a patient with long-lasting pain not accompanied by other unfavorable prognostic indicators. So what might be the solution? Watch for my next post.
