Acute vs. Chronic Pain

What kind of pain am I experiencing?

This should be one of the first questions asked when met with challenging acute or chronic pain. The treatment of acute pain is usually more focused on resting the injury to allow the tissue time to recover. In some cases such as an acute back sprain, there are medications that a doctor can prescribe for a short course. The common pain treatments are true here such as REST, ICE, COMPRESS, and ELEVATE (RICE), which will help most acute injuries. Acute pain is expected to improve over time.

 

Acute Pain

Acute pain is frequently related to one specific injury or disease and should be most intense directly after the injury with gradual improvement over days and weeks. Frequently, the acute pain will improve with or without medications, and over time there may be no evidence there was ever pain present.

Examples of acute pain include childbirth, surgery, trauma such as a fall or sprain, or burns.

Chronic Pain

Chronic pain, however, is in many cases a pathological process, reflecting the brain and body developing a persistent or exaggerated response despite the body’s recovery. The cut off for chronic pain by physicians is pain of three months duration. Even though the injury may look healed from the outside, the nervous system and body may have a sensitization to painful stimulation. This causes an exaggerated or amplification pain response when compared to previously undamaged tissue. At times, this response can be so amplified that even painless stimulation (such as clothes or bedsheets touching the skin) can become painful.

Good practices to follow

Try to be patient

Both acute and chronic pain are complex, and determining the correct treatment path (whether focused on more biological, physical, psychological, or social components) will require intensive time and effort from the patient and his or her doctor.

Optimize daily activities

The treatment of chronic pain can be more complex because the tissue may already be mostly or completely healed, and yet the pain persists. The treatment of chronic pain is expected to be slower because it may involve the rewiring of the nervous system to remove the abnormal response to stimulation. There is greater variation in how much chronic pain will improve, and the focus in chronic pain is sometimes optimizing daily functional activities such as grocery shopping, going to work, enjoying hobbies, etc.

References
  1. Thompson, K.; Johnson, M.I.; Milligan, J.; Briggs, M. Twenty-five years of pain education research-what have we learned? Findings from a comprehensive scoping review of research into pre-registration pain education for health professionals. Pain 2018, 159, 2146–2158. Treede, Rolf-Detlef, et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain 160.1 (2019): 19-27. Wade DT, Halligan PW. The biopsychosocial model of illness: a model whose time has come. Clin Rehabil. 2017 Aug 1;31(8):995–1004. Arnedt-Nielsen L, Morilon B, Perrot S, et al. Assessment and manifestation of central sensitisation across different chronic pain conditions. Eur J Pain. 2018;22(2):216–241