The term ‘acute pain’ refers to pain that has been present for less than three months (Bonica 1953; Merskey 1979). Successful management of pain in the acute phase is essential to prevent transition to chronic pain, which presents a significant individual, social and financial burden. Chronic pain is pain that has been present for longer than three months (Merskey and Bogduk 1994).
The NHMRC (1999) cites a number of misconceptions about the management of acute pain, including a lack of understanding of the pharmacokinetics of analgesics, mistaken beliefs about addiction, poor knowledge of dosage requirements, concerns about side effects and the concept that pain is not harmful.
Factors Influencing the Progression from Acute to Chronic Pain
Individuals vary in their potential to develop chronic pain. A combination of behaviours, beliefs and emotions may be involved in the transition from acute to chronic pain (Linton 2002). When pain is unrelieved over time, or if there are recurrent episodes of pain, persistent pain may develop.
The development of chronic pain is likely to be the result of small, cumulative changes in lifestyle that have been made to cope with acute musculoskeletal pain (Linton 2002). The intensity, duration and character of the pain influence the psychosocial response and the psychosocial response in turn influences the course of events.
There is strong evidence that psychosocial factors at work (i.e. occupational factors) are tied to the development of chronic pain. Job satisfaction may protect against the progression from acute low back pain to chronic low back pain. It is essential to identify those at risk of developing chronic pain and to intervene early to prevent this occurrence.
Australian Acute Musculoskeletal Pain Guidelines Group;2003; Evidence-based Management of Acute Musculoskeletal Pain; Bowen Hills: Australian Academic Press Pty. Ltd.