title: Acute to chronic pain transition in extremity trauma: A narrative review for future preventive interventions (part 1).
abstract: BACKGROUND
  Several studies have been conducted over the last decade that describe the issue of pain and prognostic factors of acute to chronic pain transition post extremity trauma (ET). However, no thorough interventions to prevent chronic pain development in ET patients have yet been proposed.
  
  
  OBJECTIVE
  This first part of a series of two articles aimed to provide a comprehensive analysis of literature on the epidemiology of pain post-ET, the impact of persistent pain on ET patients and the relevant biological transformations involved in acute to chronic pain transition. The second article will focus on risk and protective factors relating to chronic pain that could potentially assist in the development of preventive interventions.
  
  
  METHODS
  A narrative review of the literature was undertaken. Databases were searched to identify relevant studies and seminal works on the topics of interest.
  
  
  RESULTS
  The review revealed that acute pain converts to chronic pain in up to 86% of ET patients. Analysis of study findings also indicated that chronic pain interferes with activities of daily living and capacity to work. Weak associations between chronic pain and anxiety as well as depression have been demonstrated. Anxiety and depression have been identified as important predictors of chronic pain post-ET. Neuro-immunological transformations, genetics and an emotional shift in the brain circuitry involved in nociception have been shown to contribute to the transition towards chronic pain.
  
  
  CONCLUSIONS
  This narrative review supports the view that acute to chronic pain transition is a prevalent and significant issue post-ET. It also provides information about patients who present a higher risk of chronic pain and features that should be integrated in preventive interventions as well as methodological considerations pertaining to the evaluation of such interventions.
authors.affiliation: Ingram School of Nursing, McGill University, 3506 University Street, Montréal H3A 2A7, Canada; Departments of Nursing, Orthopedics and Trauma, Hôpital du Sacré-Coeur de Montréal, 5400 Boulevard Gouin Ouest, Montréal H4J 1C5, Canada; Research Centre, Hôpital du Sacré-Coeur de Montréal, 5400 Boulevard Gouin Ouest, Montréal H4J 1C5, Canada. Electronic address: melanie.berube.hsc@ssss.gouv.qc.ca.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Bérubé
authors.affiliation: Centre de recherche du Centre of the Centre hospitalier de l'Université de Montréal (CRCHUM), Saint-Antoine Building, 850 Saint-Denis Street, Montréal H2X 0A9, Canada.
authors.forename: Manon
authors.initials: M
authors.lastname: Choinière
authors.affiliation: Departments of Nursing, Orthopedics and Trauma, Hôpital du Sacré-Coeur de Montréal, 5400 Boulevard Gouin Ouest, Montréal H4J 1C5, Canada; Research Centre, Hôpital du Sacré-Coeur de Montréal, 5400 Boulevard Gouin Ouest, Montréal H4J 1C5, Canada; Surgery Department, Faculty of Medicine, Université de Montréal, C. P. 6128, succursale Centre-ville, Montréal H3C 3J7, Canada.
authors.forename: Yves G
authors.initials: YG
authors.lastname: Laflamme
authors.affiliation: Ingram School of Nursing, McGill University, 3506 University Street, Montréal H3A 2A7, Canada; Research Centre, Hôpital du Sacré-Coeur de Montréal, 5400 Boulevard Gouin Ouest, Montréal H4J 1C5, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, 3755 chemin Côte-Ste-Catherine, Montréal H3T 1E2, Canada.
authors.forename: Céline
authors.initials: C
authors.lastname: Gélinas
mesh_terms: D001134:Arm Injuries / Q000451:nursing*; D004638:Emergency Treatment; D005544:Forecasting; D006801:Humans; D007869:Leg Injuries / Q000451:nursing*; D059408:Pain Management / Q000639:trends*; D010147:Pain Measurement; D010148:Intractable Pain / Q000451:nursing / Q000517:prevention & control*
keywords: Acute pain; Acute to chronic pain transition; Chronic pain; Disability; Epidemiology; Extremity trauma; Limb injury; Psychological distress