Solving the Persistent Pain Puzzle PART 2: Acute vs Chronic Pain

by

What is the Difference between Acute and Chronic Pain?

 

Chronic pain isn't acute pain that simply didn't go away.  It is a completely different animal that requires different methods of assessment and treatment.  

So how does chronic pain differ to acute pain?  Why does using the same treatment for chronic as acute pain simply not work?

Firstly, it’s important to compare, in a general sense, the differences between chronic and acute pain as they are definitely not the same beast.

Acute Pain:

  • Involves trauma (“I rolled my ankle”);
  • Generally involves clear structural damage (the ankle ligament was torn);
  • Damage is usually seen on imaging (MRI shows your torn ligament);
  • The pain is located where the damage is (in the ankle over the torn ligament);
  • Often a single cause and single structure damaged;
  • Usually easier to define, diagnose and treat;
  • Prognosis and course of treatment is more predictable – acute pain is a much simpler problem;
  • Rest helps healing and to settle the pain but rehab is required to prevent recurrence and get back normal function (so you don’t keep on rolling that ankle).

 

Chronic (also termed persistent) pain:

  • The pain is usually located in a different place to the cause;
  • Rarely (
  • Unable to diagnose or see the cause on imaging or blood tests most of the time;
  • Often multiple areas of pain are present;
  • Causes are NOT trauma – they are more insidious, there are usually lots of contributing factors which are not obvious but rather more subtle;
  • It’s the interaction between these many contributing factors and your unique body that together adds up to produce your chronic pain symptoms. Chronic pain is a summative effect involving complex interactions with your anatomy, physiology and genetic predisposition.

 

This is why treating persistent pain like an acute injury simply doesn’t work.  The RICE regimen (Rest, Ice, Compression, Elevation) is irrelevant (there’s no superficial swelling in a sore back). Electrotherapy gadgets and medication have been shown to have no lasting effect as they don’t eliminate the causative factors, while rest tends to make the condition worse over time.

So what do we do with persistent or chronic pain?  In our next post we’ll explain more about how to manage this challenging problem.