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Evaluating the Association Between Acute and Chronic Pain After Surgery

Impact of Pain Measurement Methods

Gilron, Ian MD, MSc, FRCPC*; Vandenkerkhof, Elizabeth DrPH; Katz, Joel PhD; Kehlet, Henrik MD, PhD§; Carley, Meg BSc

The Clinical Journal of Pain: July 2017 - Volume 33 - Issue 7 - p 588–594
doi: 10.1097/AJP.0000000000000443
Original Articles

Aim/Objectives/Background: There is a need to predict chronic (Z3mo) postsurgical pain (CPSP). Acute (<7 d) pain is a predictor, that is, more severe pain is associated with higher CPSP risk. However, reported associations vary widely.

Methods: Using a systematic search, we examined associations between 2 acute pain measures (pain at rest [PAR] and movement-evoked pain [MEP]) and CPSP outcomes (considering severity vs. any “nonzero” pain only) in 22 studies.

Results: Seven studies reported the relationship between CPSP and both PAR and MEP. Of these, 2/7 reported no association, 3/7 reported significant associations for both PAR and MEP, 1/7 reported an association for PAR only, and 1/7 reported an association for MEP only. Six of another 7 studies reporting only the association for MEP found a significant relationship. Three of the 5 studies that did not specify whether acute pain outcomes were PAR or MEP reported a significant relationship. Another 3 studies reporting a relationship with CPSP did not specify whether this was for PAR, MEP, or both. All investigations incorporating severity of CPSP in their analyses (n=7) demonstrated a significant relationship, whereas only 10 of the 15 studies that dichotomized CPSP outcome as “no pain” versus “any”/“nonzero pain” were positive.

Conclusions: Overall, evidence for an association between acute and chronic pain is moderate at best. However, closer attention to pain measurement methods will clarify the relationships between acute pain and CPSP. We propose that future CPSP predictor studies assess both PAR and MEP acutely and also incorporate CPSP severity in their analyses.

*Departments of Anesthesiology & Perioperative Medicine and Biomedical & Molecular Sciences, Kingston General Hospital

School of Nursing, Queen’s University, Kingston

Department of Psychology, York University, Toronto, ON, Canada

§Section for Surgical Pathophysiology, Rigshospitalet Copenhagen University, Copenhagen, Denmark

Supported by CIHR (Canadian Institutes of Health Research, Ottawa, Canada) Grant #79522 to E.V. and a CIHR-Pfizer Rx&D Collaborative Research Investigator Program (CIHR Grant #MSH-55041, Ottawa, Canada) to I.G. J.K. is supported by a Canadian Institutes of Health Research (Ottawa, Canada) Canada Research Chair in Health Psychology. I.G. has received support from Adynxx (San Francisco, CA), Taris Biomedical (Lexington, MA), Astra Zeneca (London, UK), Pfizer (New York, NY), and Johnson & Johnson; and has received grants from the Canadian Institutes of Health Research (Ottawa, Canada), Physicians’ Services Incorporated Foundation (Toronto, Canada), and Queen’s University (Kingston, Canada). The other authors declare no conflict of interest.

Reprints: Ian Gilron, MD, MSc, FRCPC, Departments of Anesthesiology & Perioperative Medicine and Biomedical & Molecular Sciences, Kingston General Hospital, Queen’s University, 76 Stuart St, Kingston, ON, Canada K7L 2V7 (e-mail:

Received July 21, 2016

Received in revised form October 27, 2016

Accepted September 17, 2016

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