Pain chronification: what should a non-pain medicine specialist know?

Figures & data

Figure 1. From the physiological perspective, an imbalance between enhanced ascending nociceptive inputs and inadequate inhibitory descending pathways is responsible for pain chronification⁴⁵. Reproduced with permission from Coluzzi et al.⁴⁵.

Figure 2. This model depicts likely determinants that contribute to the risk of onset and maintenance of common chronic overlapping pain conditions (CPPCs). These factors are determined by genetic variability and environmental events that determine an individual’s psychological profile and pain amplification status. These two primary domains are interactive and influence the risk of pain onset and persistence. Likely modifiers of the interaction between genetic and environmental factors include sex and ethnicity⁷². Abbreviations. MAO, monoamine oxidase; GAD65, glutamate decarboxylase; NMDA, N-methyl-D-aspartic acid; CREB1, CAMP responsive element binding protein 1; GR, glucocorticoid receptor; CACNA1A, calcium voltage-gated channel subunit alpha1A; POMC, proopiomelanocortin; NET, norepinephrine transporter; BDNF, brain-derived neurotrophic factor; NGF, nerve growth factor; IKK, IkB kinase; COMT, catechol-O-methyl transferase.

Table 1. Main factors influencing the pain chronification process.

Positive factors	Negative factors
Social support (marriage/family)	Poor health status
High level of education	Type (e.g. neuropathic) and severity of pain
Coping strategies	Depression
Work satisfaction	Stress
Appropriate communication with HCPs	Litigation
Adequate self-recognition	Fear avoidance
	Perceived injustice
	Catastrophizing

Abbreviation. HCPs, health care professionals.

Coluzzi F, Fornasari D, Pergolizzi J, et al. From acute to chronic pain: tapentadol in the progressive stages of this disease entity. Eur Rev Med Pharmacol Sci 2017;21:1672-83

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Maixner W, Fillingim RB, Williams DA, et al. Overlapping chronic pain conditions: implications for diagnosis and classification. J Pain 2016;17(9Suppl):T93-107

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