The Vulnerable Patient

Jana M. Mossey

doi:10.1093/med/9780197649176.003.0004

This chapter addresses the occurrence, risk factors for, and consequences of pain across the life span with a focus on identification of groups vulnerable to chronic pain conditions in six agespecific groups: newborns, preschool children, preadolescent and adolescent youth, young adults, middleaged adults, and elderly individuals. Despite the absence of a common chronic pain assessment tool used across studies, several findings regarding chronic pain vulnerability and impact have emerged from review of the relevant pain literature. First, due to frequent receipt of medically indicated, painful neonatal intensive care unit procedures, lifelong chronic pain vulnerability begins at birth for preterm infants. Second, most chronic pain risk factors are relevant for all agespecific groups. Excluding age, sex, and genetic makeup, most chronic pain risk factors—including persistent exposure to racial discrimination and/or poverty, personal maltreatment, physical inactivity, obesity, nonrestorative sleep, multiple comorbid medical conditions, anxiety and/or depression, and behaviors such as smoking—are preventable or modifiable. Third, experienced chronic pain increases the likelihood of future chronic pain episodes. Fourth, the negative impacts of risk factors that become persistent (e.g., racial discrimination, physical inactivity, and obesity) accumulate over time. Finally, with aging, most risk factors increase in strength. Falling and fear of falling emerge as additional chronic pain risk factors. These findings emphasize the potential benefits of aggressive primary prevention efforts and the importance of monitoring those whose chronic pain occurs early in life. Recommendations to achieve these aims are provided.

The Vulnerable Patient

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The Vulnerable Patient

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Abstract

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