Pain - Acute or Chronic?
Pain is defined as, “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage,” and is an important mechanism for our survival.
Initially, we sense pain for its location and intensity. An emotional response may follow, depending on the degree of unpleasantness. Lastly, we then interpret our previous experiences, anxieties and decisions on how we should respond to it.
Acute pain often resolves within 3 months, and is associated with the activation of nerve endings in our tissues called nociceptors.
Nociceptors are activated by either physical injury or disease to tissues, where particular substances sensitize the nerves to inform the brain of the threat. This type of pain may be felt through the inflammation of a sprained ankle, or with the contact of your skin against a hot object.
Chronic pain either lasts longer than 3 months, or continues to occur longer than the normal timeline for tissue healing.
Pain that becomes chronic is associated with a condition in our brain and spinal cord called central sensitization. The pain may become augmented, persistent and more widespread, without any redness or swelling often found when inflammation is present.
As the brain becomes more sensitized, pain may be felt by a non-painful source (ex. light touch) and with a higher intensity than before. In addition, brain imaging techniques have shown significant changes in both structural and functional connectivity within our brains to some chronic pain conditions compared to those without.
Examples of specific chronic pain conditions may include: neuropathic (nerve related), complex regional pain syndrome (CRPS), chronic musculoskeletal pain (ex. low back) and headaches.
Chronic pain requires a holistic, individualized approach that acknowledges how the biopsychosocial model of pain affects everyday life. Biological aspects may involve the extent of physical injury to our nerves and tissues. Psychological aspects may focus on anxiety, sleep disturbance, weather changes and moods, and social aspects may involve relationships, occupation and financial stability.
There are individuals with chronic pain who manage to live a good life. Pain may be reduced by incorporating optimism, self-rewarding goals, recording positive experiences through a written log and the balance between activity and rest.
Overall, physical therapists often treat acute pain, and can assist clients with chronic pain as a part of an interdisciplinary team. Interventions may include: education, individualized exercises and coping strategies, dry needling, hands on treatment, taping or modalities such as heat or TENS machines.
Crofford LJ. Chronic Pain: Where the Body Meets the Brain. Transactions of the American Clinical and Climatological Association. 2015;126:167-183.
Dysvik E, Furnes B. Living a meaningful life with chronic pain – further follow‐up. Clinical Case Reports. 2018;6(5):896-900. doi:10.1002/ccr3.1487.
McAllister M., What is Central Sensitization?, ICP Institue for Chronic Pain, accessed 1 October 2018, <http://www.instituteforchronicpain.org/understanding-chronic-pain/what-is-chronic-pain/central-sensitization>.
Rajapakse D, Liossi C, Howard RF Presentation and management of chronic pain Archives of Disease in Childhood 2014;99:474-480.