What duration of shoulder pain is considered chronic?

Definition of Chronic Shoulder Pain

Shoulder pain is considered chronic when it has persisted for more than 3 months. 1, 2

Evidence-Based Definition

The definition of chronic shoulder pain follows the general consensus for chronic pain conditions:

• The International Association for the Study of Pain (IASP) defines chronic pain as "pain that persists beyond normal tissue healing time, which is assumed to be three months" 1
• This 3-month threshold is consistently applied across various pain conditions and body regions 1
• Specifically for shoulder disorders, pain lasting longer than 6 months is definitively considered chronic 2, though the 3-month threshold is more commonly used for initial classification

Clinical Significance of the Chronic Pain Timeline

The transition from acute to chronic pain involves important physiological changes:

• Pain persisting beyond 3 months typically involves central sensitization and neurobiological changes that make it more resistant to standard treatments 3
• Unlike acute pain that resolves with tissue healing, chronic shoulder pain involves sensitization of peripheral and central nervous systems 3
• This timeline distinction is critical because treatment approaches differ significantly between acute and chronic shoulder pain

Prognostic Implications

The duration of shoulder symptoms at presentation is a strong predictor of outcomes:

• Only about 50% of new shoulder pain episodes achieve complete recovery within 6 months 4
• Patients with acute shoulder symptoms (less than 6 weeks) show more favorable outcomes with larger pain reduction and improved functional ability compared to those with chronic symptoms 5
• Predictors of outcome differ between acute and chronic shoulder pain, with psychosocial factors playing a more significant role in chronic cases 5

Clinical Application

When evaluating shoulder pain:

• Document the precise duration of symptoms to properly categorize as acute (<6 weeks), subacute (6-12 weeks), or chronic (>3 months) 5
• Recognize that pain persisting beyond 3 months may require more comprehensive management approaches
• Be aware that different predictors influence outcomes in acute versus chronic shoulder pain:
  • For acute pain: baseline disability scores and pain intensity are key predictors 5
  • For chronic pain: psychosocial factors like pain catastrophizing become more important 5

Understanding the timeline for chronic shoulder pain classification helps guide appropriate treatment selection and set realistic expectations for recovery.