Transition of Acute Icu Pain to Chronic Post-Icu Pain: Risk Factors and Prevention

Background: Post-intensive care syndrome (PICS) encompasses a constellation of physical, cognitive, and psychological impairments that persist following intensive care unit (ICU) discharge. Among these, chronic post-ICU pain represents a significant yet underrecognized component that profoundly impacts quality of life and functional recovery. Pain experienced during critical illness can transition from acute nociceptive pain to chronic pain states through complex neuroplastic mechanisms involving peripheral and central sensitisation. Objective: This review examines the epidemiology, pathophysiological mechanisms, risk factors, and evidence-based prevention strategies for the transition from acute ICU pain to chronic post-ICU pain. Methods: A comprehensive review of current literature was conducted, focusing on studies published between 2012 and 2025, examining the incidence, mechanisms, and prevention of chronic pain in ICU survivors. Results: Chronic pain affects 17.7% to 44% of ICU survivors, with the shoulder being the most commonly affected site. Key risk factors include prolonged ICU length of stay, severe sepsis, female gender, hyperinflammation, and post-traumatic stress disorder. The transition involves peripheral sensitisation, central sensitisation, neuroinflammation, and maladaptive neuroplasticity—prevention strategies centre on the ABCDEF bundle, multimodal analgesia, early mobilisation, and psychological support. Conclusion: Chronic post-ICU pain represents a preventable complication of critical illness. Systematic implementation of evidence-based protocols during ICU care can significantly reduce the incidence and impact of chronic pain in survivors.