Chronic pain reconsidered
Open accessAbstract
Chronic pain has been traditionally defined by pain duration, but this approach has limited empirical support and does not account for chronic pain's multi-dimensionality. This study compared duration-based and prospective approaches to defining chronic pain in terms of their ability to predict future pain course and outcomes for primary care patients with three common pain conditions: back pain (n=971), headache (n=1078), or orofacial pain (n=455). At baseline, their chronic pain was classified retrospectively based on Pain Days in the prior six months and prospectively with a prognostic Risk Score identifying patients with "possible" or "probable" chronic pain. The 0-28 Risk Score was based on pain intensity, pain-related activity limitations, depressive symptoms, number of pain sites, and Pain Days. Pain and behavioral outcomes were assessed at six-month follow-up, and long-term opioid use was assessed two to five years after baseline. Risk Score consistently predicted clinically significant pain at six months better than did Pain Days alone (area under the curve of 0.74-0.78 for Risk Score vs. 0.63-0.73 for Pain Days). Risk Score was a stronger predictor of future SF-36 Physical Function, pain-related worry, unemployment, and long-term opioid use than Pain Days alone. Thus, for these three common pain conditions, a prognostic Risk Score had better predictive validity for pain outcomes than did pain duration alone. However, chronic pain appears to be a continuum rather than a distinct class, because long-term pain outcomes are highly variable and inherently uncertain.
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Definitions based solely on pain duration do not consider the multidimensional nature of chronic pain, namely activity limitations and participation restrictions.
“Although conceptually appealing, this hotly debated7 approach does not consider the multidimensional nature of chronic pain, namely, the presence of activity limitations and participation restrictions,5,17,30–36 classifications recognized by the World Health Organization.37”
From Prevalence and Profile of High-Impact Chronic Pain in the United States (2019) · cites this paper as [31]
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- Authors
- Von Korff, M., & Dunn, K. M.
- Affiliations
- Keele University (GB)
- ORCID
- Dunn, Kate M.
- Venue
- Pain
- Published
- 2008-08-31
- Volume
- 138
- Issue
- 2
- Pages
- 267-276
- ISSN
- 0304-3959 (ISSN-L)
- PMC
- PMC2613775
- OpenAlex
- W2072409292
- Cited by
- 205
- References
- 41
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 6 · 2023: 3 · 2022: 11 · 2021: 8 · 2020: 8 · 2019: 15 · 2018: 9 · 2017: 9 · 2016: 16 · 2015: 14 · 2014: 23 · 2013: 18 · 2012: 10
- FWCI
- 11.54
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (R01DA022557)
- National Institute of Dental and Craniofacial Research (P01DE008773)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- chronic pain, pain duration, prognostic risk score, back pain, headache, orofacial pain, depressive symptoms, pain-related worry, chronic opioid use, physical function, unemployment, primary care patients
- MeSH terms
- Adolescent, Adult, Aged, Analgesics, Chronic Disease, Female, Humans, Male, Middle Aged, Pain, Pain Measurement, Surveys and Questionnaires, Pain Management
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