One of the things that can be difficult with respect to people who have acute pain is not thinking about the possible situation one, or three months out. Every so often patients deviate from the norm, which would be the healing and resolution of that acute pain. And it’s very easy, with an acute pain patient, maybe someone who’s been in an automobile accident and had surgery, to use a cookbook kind of formula to treat them, and then to gauge all of their progress by a reduction in their pain score. I call that a reductionist approach. But there is also a psychosocial dimension that needs to be considered. What was happening to the patient before this acute pain-causing event? What’s going to be happening to them while it’s going on and what’s going to happen to them from a psychosocial perspective if the acute pain doesn’t resolve? These factors can set the stage for a subacute pain period—between one month and 90 days, and that middle 60 days is probably our best opportunity to forestall the transition from acute pain to chronic pain because the longer it goes on, the better the human body is at adapting to that scenario and the tougher it could be to treat.
I think there are things that people in primary care can do to forestall the transition from acute to chronic pain, and one of those things is actually asking the patient how they’re doing outside of the envelope of their pain. We need to consider everything else about the person that’s going on – work, social influences, sleep, appetite and function. I would love for primary care to be able to claim greater success in pain treatment. I would love for the definition of pain treatment to be recast as the negotiation of pain and function, and I think the primary care clinician is the best suited to lead that negotiation, because presumably they know the patient better than anybody else, certainly way better than a consultant.