A great deal of material has been published on the chronification of pain, with estimates regarding when a painful condition should be defined as chronic varying from 7 weeks to 6 months. A number of different models have been worked out to explain the factors responsible for pain chronification:
In 1994, Basler described ”the 5 dimensions of chronic pain” based on the following decisive factors:
- Duration of illness
- Number of attempted treatments (number of physicians, different therapies, operations, and rehabilitation measures)
- Psychological concerns (depression, anxiety, catastrophism, helplessness)
- Social concerns (altered social roles, social isolation)
- Effect on work (days missed, job loss, retraining, early retirement)
The development of chronic pain always involves the complex interplay of a number of individual factors that are potential initiators. Potential risk factors that can play a role in individual cases are:
- Job-related factors
- Educational status
- Professional status
- Job satisfaction
- Income
- Retirement wish
- Sociodemographic factors
- Age
- Sex
- Marital status
- Social network
- Lifestyle and level of physical exercise
- Alcohol
- Drugs
- Smoking
- Lack of physical exercise
- Psychological factors
- Depression, anxiety
- Stress
- Pain history
- Duration of sick leave
- Duration and intensity of pains
- Whether several pain regions are affected
Chronic pain may develop into a pain disorder in its own right that is increasingly disengaged from its primary cause (simple back pain, for example). Treatment of an existing pain disorder requires a multimodal therapeutic concept with an overall approach that addresses all of the causes of the chronic pain - physical, psychological and social.
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