The progression from acute to chronic pain.

PURPOSE OF REVIEW: The persistence of pain after surgical procedure or trauma has become a major focus of interest and its prevention now represents a challenge as an indicator of quality of healthcare. The only way to develop effective strategies to prevent the development of chronic pain is to better understand the mechanisms involved in the progression from acute to chronic pain, with the aim to target high-risk patients and to adapt perioperative management. RECENT FINDINGS: Several important risk factors involved in chronic pain development after tissue injury have been identified, underlining how much the phenomenon is complex and multifaceted. Recent studies have highlighted some important points on which to focus, mainly during the acute and subacute postinjury periods. These studies promote a more dynamic approach related to a better evaluation of acute pain resolution using individualized pain trajectories, the assessment of endogenous pain-modulatory processes and individual's psychological flexibility when facing physical threat and pain. SUMMARY: A dynamic view of both physiological and psychological response of an individual after injury (trauma, surgery) should improve our ability to target predisposed patients who might develop persistent pain. We should then be more able to provide those patients with the most appropriate preventive management.