Understanding the Science Behind Acute and Chronic Pain Management

A better understanding of acute and chronic pain gives you more health choices and better control over your life. When you understand the basic science behind acute and chronic pain, you are empowered to seek treatment sooner and are able to develop skills that can improve the quality of your life.

Acute pain

Have you ever developed a sudden stress headache, twisted an ankle or experienced muscle soreness after strenuous lifting? Then you have experienced acute (short term) pain.

Acute pain typically results from an injury or is caused by a specific illness. It typically lasts under 30 days. Although unpleasant, it serves a useful biologic purpose. It is a protective system warning you to stop a harmful behavior (like lifting incorrectly), and to seek treatment. Most commonly, acute pain improves on its own as the body heals. In other instances, however, things don’t get better on their own and a visit to a doctor is necessary. Consulting a doctor is necessary, sometimes to rule out a serious condition (such as a herniated disc that is compressing a nerve or an undiagnosed fracture), and other times to help speed up an abnormal healing process.

Acute pain can result from many sources including:

• Tension-type headache (“stress headache”)
• Herniated discs
• Sport injuries
• Broken bones (i.e. spinal compression fracture)
• Surgery
• Infections

Chronic Pain

Chronic (long term) pain outlasts what is considered a normal time course for healing. Typically this is within three to six months. In some cases, however, the pain becomes the disease in itself. Chronic pain can persist after an injury (fracture, surgical site) has apparently healed or it can occur without any indication of an injury or illness. It serves no biologic purpose, and has no recognizable end-point. It is accompanied by many unwanted physical and mental effects such as sleep disturbances, appetite changes, depression, disability, and anxiety. Chronic pain often requires diagnosis and treatment by a pain specialist (pain doctor).

Chronic pain can result from:

• Back pain (due to wear and tear seen with aging)
• Osteoarthritis (“wear and tear” arthritis in the large joints – knees, hips)
• Rheumatoid arthritis (immunologic-type arthritis in small joints – wrists, fingers)
• Fibromyalgia
• Diabetic peripheral neuropathy (hand or foot pain due to diabetes)
• Migraine headaches
• Cancer
• Post-surgical pain syndrome (long-term pain after a surgery)
• Complex Regional Pain Syndrome (pain, swelling, skin changes, joint pain after trauma or nerve injury in the arms/legs)

The Difference Between Acute and Chronic Pain

It is useful to consider acute vs. chronic pain as different clinical conditions, with different durations and different underlying causes. Acute pain results from direct tissue injury that causes inflammation or nociceptive pain (pain perceived by nerves in the injured area).

Chronic pain involves complex changes in how the nerves in the spinal cord and brain communicate and function. Chronic pain can start after an injury or illness (sprained back, arthritis, cancer). It can also develop in the absence of an actual trigger. Much like a “battery bunny” that just keeps on going, chronic pain persists (or even gets worse) if not treated.

Treating Acute Pain

In most cases, acute pain will disappear on its own or with minimal effort from a patient, after stretching, anti-inflammatories, and rest. However, when things are not going as planned, it is wise to consult a doctor in order to rule out possible underlying fractures, trauma, or even an undiagnosed disease such as cancer. It is important to treat acute pain, since unattended acute pain is more likely to become chronic pain. It is, therefore, best that patients seek help for pain early, in order to prevent a shift to chronic pain. Some examples of acute pain that can become chronic are post-surgical pain and facial nerve pain (trigeminal neuralgia).

Acute pain is initially addressed by a primary care or an emergency room doctor who identifies and treats the problem, or refers a patient to a pain specialist. However, it is appropriate to consult a pain specialist directly if the acute pain is a flare-up of a persistent problem, especially one that has been treated before in a pain management clinic.

Treating Chronic Pain

Chronic pain treatment is more complicated and often requires care from a pain specialist,a doctor who has received specialized training in a branch of medicine known as pain management. One advantage of seeing a pain specialist is that they perform advanced procedures (like pain-relieving injections) in their office, while using X-ray guidance. X-ray use can make the procedure safer and allows medications to be applied to the nerve roots or in the epidural space (an anatomic space that lies very close to the spine), where they have a direct effect. Another advantage of seeing a pain specialist is that they treat a large number of chronic pain patients and may be able to diagnose conditions that may have been previously missed or misdiagnosed.

At National Spine and Pain Centers (NSPC)our pain specialists have the ability and knowledge to diagnose the root-causes of your pain. They use a variety of proven treatments to decrease pain and to improve the quality of life of patients living with pain.

Treatments Available at NSPC

• Peripheral nerve blocks
• Facet joint injections
• Nerve blocks
• Epidural steroid injections
• Trigger point muscle injections
• Spinal cord stimulation
• Peripheral nerve stimulation
• SI (sacroiliac) joint injection

The most commonly reported pain conditions in the United States:

• Low back pain (27%)
• Severe headache/migraine (15%)
• Neck pain (15%)
• Facial ache (4%)

Some other interesting facts about pain are:

• Back pain is the leading cause of disability in Americans under 45 years old.
• Both acute and chronic pain are an enormous problem in the United States, costing 650 million lost workdays and $65 billion a year.
• According to the National Health Institute (NIH): Scientists are developing new ways to measure pain. They are using computer-assisted technology, combined with existing methods to measure pain, to compare pain across different patient groups.
• Pain is the number one reason Americans access the health care system. It is a leading cause of disability and it is a major contributor to health care costs.
• Chronic pain is the most common cause of long-term disability.
• Pain can be a chronic disease and can occur alongside other conditions, such as depression, post-traumatic stress disorder, traumatic brain injury. Pain can also become a barrier to receiving adequate cancer treatment.
• Women and men perceive pain, and may respond to treatment, differently.