1. Medicine Faculty of Porto University Biostatistics and Medical Informatics Department Risk factors which influence the evolution of acute pain into chronic pain Systematic Review Class 6

2. Introduction Pain Unpleasant sensory and emotional experience associated with actual or potential tissue damage [1]. Acute Pain & Chronic Pain Chronic pain is a pain without apparent biological value that has persisted beyond the normal tissue healing time (taken to be three months), whereas acute pain tends to have shorter duration, as well as it is connected with tissue lesions [2]. [1] http://www.iasp-pain.org; IASP – International Association for the Study of Pain [2] Smith BH; Hopton JL and Chambers WA; Chronic pain in primary care; Family Practice; 1999; 16; 475-482

3. To review systematically the literature regarding risk factors which influence the evolution of acute pain into chronic pain Objective

4. Methods Inclusion criteria: Cohort studies that refer to the factors which influence the evolution of acute pain into chronic pain. Exclusion criteria: Language restriction: only studies in English or Portuguese would be included. Studies that are not related with the context of our review. Studies that do not include cohort studies. Studies that do not refer the evolution of acute pain into chronic.

5. Organization of reviewer groups: 4 Reviewer Groups: three groups of 2 elements and one group of 3 elements Revision by abstract: All groups with 6 articles Two groups with 93 articles and two groups with 92 articles Revision by full text: Three groups with 17 articles and one group with 18 articles Assessment Protocol

6. Fluxogram

7. SPSS Analysis

9. Results ReferencePublication year Country Sample Size Follow up Period (months) Follow up losses Kind of pain Francen, M. et al. Spine2002Australia85420586 Low back pain Williams, R. et al. Archives of PMR 1998USA11766 Low back pain Andersson, H. European Journal Pain 2003Sweden21414473 Neck- shoulder pain Main features of the studies used in the review

10. ReferenceInclusion CriteriaExclusion Criteria Francen,M. et al. nurses unavailable people nurses' aids heavy manual workers drivers Williams, R. et al. age between 15 and 18 years prior episode of back or other pain on a daily basis lasting 2 weeks or longer back pain (T6 or below) that had been present "on a daily bases" from the previous 8 weeks major medical illness back pain as the only pain problem taking medications known to affect mood in good health otherwiseprior back surgery available for the follow-up assessment period pain secondary to neoplastic disease osteomyelitis, or fracture since the clinical course of these conditions differs from the "usual" back disorder Andersson, H. neck/shoulder pain with or without reflexion in arms unavailable people pain in at least 3 regions of arms/legs without chronic pain pain in other parts of the body Inclusion and exclusion criteria of the sample’s subjects

11. Reference Study factorsInfluence Francen et al. Increasing ageyes Severe radiating pain in the legsyes Lowest than normal body mass indexyes Normal body mass indexno Higher than normal body mass indexyes Oswestry disability score indicating minimal disabilityno Oswestry disability score indicating moderate disabilityyes Oswestry disability score indicating severe disabilityyes Oswestry disability score indicating extreme disabilityyes Somatic symptomsyes Anxiety and insomniayes Social dysfunctionyes Severe depressionyes Job satisfactionyes Death of someone closeyes Serious illness in self or a family memberyes Involvement in an accident by self or a family memberyes Risk factors studied in each article and trheir influence in the evolution of acute pain into chronic pain

12. New family member gainedyes Breaking off of a close relationshipyes Particular financial crisisyes Job or business loss as a result of retiring or resigningyes Beginning of a different jobyes Acceptance of income supportyes Change of duties at workyes Control over his or her behaviour and life circumstancesyes Unavailability of light duties on return to workyes Need to lift objects for about one halfno Need to lift objects for, at least, three fourths of the work day yes Need to lift or manoeuvre "extremely heavy" items regularly no Need to spend at least three fourths of the working day driving no AnderssonBent positions at workyes Williams et al.Job satisfactionyes

13. Discussion Comparison of articles according to the following items: Types of pain Population Sample’s size Follow-up period Year of publication Definition of chronic pain Inclusion/Exclusion criteria of study’s participants Risk factors studied

14. Conclusion ReferenceStudied factors Francen et al. increasing age severe radiating pain in the legs lowest than normal body mass index higher than normal body mass index Oswestry Disability score indicating moderate disability Oswestry Disability score indicating severe disability Oswestry Disability score indicating extreme disability somatic symptoms anxiety and insomnia social dysfunction severe depression job satisfaction death of someone close serious illness in self or a family member Risk factors which inflence the evolution from acute pain into chronic pain

15. involvement in an accident by self or a family member new family member gained breaking off of a close relationship particular financial crisis job or business loss as a result of retiring or resigning beginning of a different job acceptance of income support change of duties at work control over his or her behaviour and life circumstances unavailability of light duties on return to work need to lift objects for, at least, three fourths of the work Anderssonbent positions at work Williams et al.job satisfaction

16. ReferenceStudied factors Francen et al.normal body mass index Oswestry Disability score indicating minimal disability need to lift objects for about one half need to lift or manoeuvre "extremely heavy" items regularly need to spend at least three fourths of the working day driving AnderssonNo studied factors Williams et al.No studied factors Factors that do not influence the evolution from acute pain into chronic pain

17. References [1] http://www.iasp-pain.org; IASP – International Association for the Study of Painhttp://www.iasp-pain.org [2] Smith BH; Hopton JL and Chambers WA. Chronic pain in primary care, Family Practice 1999; 16; 475-482 [3] Purves AM, Penny K, Munro C et al. Defining chronic pain for epidemiological research – acessing a subjective definition, The Pain Clinic 1998; 10; 139-147. [4] IASP – Pain Clinical Updates; volume XI, No. 2; June 2003 [5] Von Korff M, Dworkin SF, Le Resche L. Graded chronic pain status: an epidemiologic evaluation, Pain 1990; 40: 279-291 [6] Bowsher D, Rigge M, Sopp L. Prevalence of chronic pain in the British population: a telephone survey of 1037 households, The Pain Clinic 1991; 4: 223-230 [7] Brattberg G, Thorslund M, Wilkman A. The prevalence of pain in the general population. The results of a postal survey in a county in Sweden, Pain 1989; 37: 215-222 [8] Fransen M, Woodward M, Norton R et al, Risk Factors Associated with the Transition From Acute to Chronic Occupational Back Pain, Spine, volume 27, number 1, pp 92-98, 2002 [9] Pai M, McCulloch M, Gorman JD et al, Systematic reviews and meta-analyses: An illustrated, step-by-step guide, The national medical journal of India, volume 17, No2, 2004 [10]Williams R et al. The contribution of job satisfaction to the transition from acute to chronic low back pain, Archives of physical medicine and rehabilitation, volume 79, pp 366-374, April 1998 [11] Andersson H. The course of a non-malignant chronic pain: a 12-year follow-up of a cohort from the general population, European journal of Pain, volume 8, pp 47-53, 2004