Chronic Pain Due to Trauma

Brief Overview: Chronic pain due to trauma is persistent pain lasting more than 3–6 months following a physical injury such as a fracture, surgery, motor vehicle accident, or workplace injury. Pain may be localized to the injured area or widespread due to central sensitization. It often includes both nociceptive (tissue-related) and neuropathic (nerve-related) pain components and can significantly affect mobility, mental health, and quality of life.

Prevalence: It is estimated that 20–30% of individuals with serious trauma develop chronic pain.

Etiology:

Tissue injury (fractures, ligament tears, surgical scars)
Nerve injury (neuropathic pain, nerve entrapment)
Central sensitization (pain pathways become overactive)
Maladaptive healing (scar tissue, poor alignment, chronic inflammation)
Psychological trauma (PTSD, anxiety) amplifying pain perception

Risk Factors:

Severe initial injury or multiple injuries
Older age with slower healing and comorbidities
Surgery following trauma (especially spine, joint, or abdominal surgery)
Nerve injury or amputation
PTSD, depression, or anxiety
Inadequate rehabilitation or prolonged immobility
Opioid overuse during acute phase

Commonly Associated Conditions:

Post-traumatic stress disorder (PTSD)
Depression and anxiety
Sleep disorders
Complex regional pain syndrome (CRPS)
Arthritis or post-traumatic osteoarthritis
Substance use disorders

Common Medications:

Analgesics: acetaminophen, NSAIDs (short-term, with caution in some)
Neuropathic pain agents: gabapentin, pregabalin, duloxetine, amitriptyline
Topical agents: lidocaine patches, diclofenac gel, capsaicin cream
Muscle relaxants: short-term only; caution in older adults
Opioids: avoid long-term; may be considered in refractory severe pain under specialist care
Adjuncts: antidepressants for mood/sleep, anti-anxiety agents if PTSD present

Common Labs, Imaging, and Tests:

Clinical history & physical exam are important
Imaging (X-ray, CT, MRI) may be used to assess structural complications (non-healing fractures, joint degeneration)
Nerve conduction studies/EMG if neuropathic pain suspected
Labs (CBC, CMP, ESR/CRP) if infection or systemic condition suspected
Pain questionnaires (Brief Pain Inventory, PTSD screening tools)

Common Symptoms:

Localized or regional pain at site of past trauma.
Burning, stabbing, tingling if neuropathic.
Aching, throbbing, or stiffness if musculoskeletal.
Swelling, tenderness, or decreased range of motion.
Fatigue, poor sleep, mood changes.
Functional impairment (difficulty walking, lifting, or performing daily activities).

Common Treatments:

Non-Pharmacologic:
- Physical therapy/rehabilitation: strengthening, flexibility, mobility training.
- Occupational therapy: adaptive strategies for daily living
- Psychological support: CBT, trauma-focused therapy for PTSD
- Complementary therapies: acupuncture, massage, mindfulness, relaxation techniques
- Lifestyle changes: pacing activities, gradual reconditioning
Pharmacologic:
- Stepwise approach with acetaminophen, topical NSAIDs, neuropathic agents.
- Cautious use of opioids (last resort, specialist-managed).
Interventional:
- Nerve blocks, epidural injections, spinal cord stimulation in select refractory cases.
- Surgery (rare, only if structural issues are not healing).

Physical Findings:

Tenderness or pain over prior injury site
Scar tissue or deformity from healed fracture/surgery
Limited range of motion
Muscle weakness or atrophy
Neuropathic findings: allodynia (pain from light touch), hyperalgesia
Signs of depression, anxiety, or avoidance behaviors

Potential Complications and Contraindications:

Complications:
- Functional decline and disability
- PTSD and depression
- Sleep disturbances
- Dependence on pain medications (especially opioids)
- Secondary musculoskeletal problems (overuse of compensating joints)
Contraindications:
- Long-term NSAID use in patients with kidney, heart, or GI issues
- Caution muscle relaxants in seniors (fall risk, confusion)
- Chronic opioid therapy unless under strict specialist oversight
- Avoid unnecessary repeat surgeries without clear benefit

General Health and Lifestyle Guidance:

Encourage low-impact physical activity (walking, swimming, tai chi). Ask your healthcare provider what exercises are recommended for you.
Use pacing strategies (alternate activity with rest)
Prioritize sleep hygiene to improve pain tolerance
Stress management: mindfulness, breathing exercises, support groups
Safe home environment (fall prevention measures)
Maintain social engagement to reduce isolation

Suggested Questions to Ask Patients:

Can you describe your pain — where is it and how long have you had it?
Does the pain feel sharp, burning, or aching?
What makes your pain worse or better?
How does your pain affect sleep, mood, or daily activities?
Do you use a cane, walker, or other support?
Have you had anxiety, nightmares, or stress related to your injury?
What medications are you taking now for pain? Do they help?
What are your goals for pain management (better sleep, more mobility, less medication)?

Suggested Talking Points:

It’s common to still have pain long after an injury has healed — the nervous system can stay sensitive.
We can manage pain better with a combination of medication, therapy, exercise, and support.
Staying gently active is important — avoiding movement can make pain and stiffness worse.
Opioids are typically not the best long-term solution; we want to focus on safer treatments.
Managing stress, sleep, and mood is part of managing pain.

Sources:

This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.