{
  "abstract": "Introduction Acute pain contributes to nearly 70% of visits to the Emergency Department (ED), and most individuals experience acute pain at some point in their lifetime. Recent studies indicate that point prevalence of pain ranges between 37.7% and 84%, while the period prevalence can be as high as 78.6%. 1 The transition from acute to chronic pain occurs in approximately 10–50% of cases, with significant implications for patients‘ quality of life, increased morbidity, and economic burden due to lost productivity.2 Preventing this transition is crucial, and understanding the predisposing factors can inform effective interventions. These risk factors are broadly categorized into preoperative, intraoperative, and postoperative domains. Preoperative Factors These factors include patient demographics, comorbidities, psychological states, pain genetics, and sociocultural influences. Key risk populations for chronic pain development include those with: • Pre-existing pain (even if not related to the surgical site), • Central sensitization syndromes like fibromyalgia, chronic migraine, or irritable bowel syndrome,3 • Psychological traits such as catastrophizing, depression, neuroticism, and anxiety,4 • Young age and female sex—females are more likely to experience chronic post-surgical pain (CPSP) due to differences in pain perception, hormonal influence, and immune responses.5 Emerging evidence has also shown that genetic and epigenetic variations, though still being elucidated, modulate pain perception and the transition to chronic pain, especially in conditions like burning mouth syndrome and migraine.6 Intraoperative Factors Certain surgical procedures have a higher risk of leading to chronic pain. These include: • Mastectomy, • Thoracotomy, and • Mesh hernioplasties.7 For example, post-thoracotomy pain is associated with nerve injury severity, while chronic pain after inguinal hernia repair is linked to ilioinguinal or iliohypogastric nerve involvement.8 Modern surgical techniques such as minimally invasive procedures and nerve-sparing approaches have shown promise in reducing these risks.9 Postoperative Factors The intensity and duration of acute postoperative pain are strongly correlated with the risk of chronicity. Poorly controlled acute pain enhances peripheral and central sensitization, thereby increasing the risk of chronic pain.10 Continuous pain assessment, early aggressive multimodal pain management, and individualized analgesic plans are critical in the postoperative period.11 Mechanisms behind chronic pain development The pathophysiology of chronic pain involves both peripheral sensitization (increased excitability of nociceptors due to inflammatory mediators) and central sensitization (hyperexcitability of dorsal horn neurons and altered descending modulation). Recent neuroimaging studies have identified alterations in brain structures and white matter connectivity, particularly in regions involved in pain processing such as the prefrontal cortex and insula.12 Intervention Strategies Prevention can be categorized into: 1. Primary Prevention Aimed at mitigating risk factors before pain onset. Strategies include: • Ergonomic corrections, • Weight management, • Mental health promotion, and • Lifestyle changes (avoiding smoking/alcohol).13 Successful primary prevention must integrate biopsychosocial components to ensure comprehensive coverage.14 2. Secondary Prevention Focuses on preventing acute pain from becoming chronic. Key strategies: • Early identification of vulnerable populations (e.g., elderly, racial minorities, those with disabilities),15 • Bridging research gaps between basic science and clinical pain management. Pain trajectories can be modified by timely multimodal analgesia, physical therapy, and psychological interventions.16 3. Tertiary Prevention Applies when chronic pain is already established. Goals include: • Reducing frequency and severity of pain, • Enhancing functional and emotional well-being. Effective interventions: • Cognitive-behavioral therapy (CBT), • Mind-body techniques (e.g., yoga, mindfulness), • Interdisciplinary rehabilitation, • Multimodal pharmacotherapy and physiotherapy.17 Technology can support tertiary prevention through web-based apps and remote monitoring, improving adherence and enabling real-time feedback.18 Follow-up and Adherence Tracking patients’ responses to interventions is crucial. Regular pain intensity ratings, functional assessments, and quality-of-life scales help optimize treatment. However, many tertiary interventions require self-management, making patient adherence a key determinant of success. Digital health tools such as mobile apps, telehealth platforms, and wearable devices are proving effective in promoting adherence and engagement in long-term pain management plans.19 Conclusion While acute pain is common, a subset of patients are vulnerable to chronicity. A multifactorial understanding—including preoperative, intraoperative, and postoperative factors—guides early intervention. Both peripheral and central mechanisms underlie chronic pain, providing multiple therapeutic targets. Prevention, particularly timely and individualized interventions, is key to reducing the burden of chronic pain and improving patient outcomes.References Mesaroli G, Amodeo LR, Edmonds JK, Kim Y, Curran JA. Pain prevalence and management in emergency departments: a systematic review and meta-analysis. Pain Res Manag. 2020;2020:9156734.van Hecke O, Torrance N, Smith BH. Chronic pain epidemiology and its clinical relevance. Br J Anaesth. 2018;120(1):e23–32.Clauw DJ, Häuser W. Fibromyalgia and the role of central sensitization in chronic pain: a systematic review. Mayo Clin Proc. 2019;94(9):1830–41.Burke SM, Woodrow C, Molnar DS. Psychological risk factors for chronic post-surgical pain: a meta-analysis. 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  "authors": [
    {
      "affiliations": [
        "Department of Anaesthesia, Sawai Man Singh Hospital, Jaipur, India"
      ],
      "name": "Samridhi Nanda"
    }
  ],
  "title": "FT08 Can we prevent the transition from acute to chronic pain?",
  "uid": "c92c6065-0b0c-5148-849c-88c371517da0"
}