Cited by 205Musculoskeletal pain and rehabilitationPediatric Pain Management TechniquesPain Management and Treatment

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Chronic pain reconsidered

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Von Korff, Michael, Dunn, Kate M.·2008·Pain

DOI 10.1016/j.pain.2007.12.010PMC PMC2613775

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Abstract

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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Authors: Von Korff, M., & Dunn, K. M.
Affiliations: Keele University (GB)
ORCID: Dunn, Kate M.
Venue: Pain
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2008-08-31
Volume: 138
Issue: 2
Pages: 267-276
ISSN: 0304-3959 (ISSN-L)
DOI: 10.1016/j.pain.2007.12.010
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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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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