Chronic pain after trauma

Chronic pain is more common following trauma than often realised. It may be due to nociceptive pain or often include a neuropathic component which can be difficult to treat. There are several pain syndromes, such as complex regional pain syndrome and post-amputation pains, which are specifically associated with trauma. These are described, as are the differences in features of nociceptive and neuropathic pain. This article aims to describe the features of chronic pain following trauma using a bio-psycho-social model. An approach to taking a comprehensive pain history and management options are also considered. A multi-disciplinary team using physiotherapists and psychologists is generally required and the importance of good rehabilitation following major trauma cannot be over-emphasised. For the physician, there are a range of pharmaceutical options available and a multimodal approach is recommended. There are also a number of non-invasive therapies on offer such as transcutaneous electrical nerve stimulation and massage. The limited role of invasive procedures is also discussed.