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Acute vs chronic pain

Pain is confusing. And it’s important to get our ideas about it straight or it can cause severe confusion.

We all think of pain in ways we have been brought up to, and it’s usually ok most of the time.

When we get a long-term problem however, our usual ways of understanding pain do not fit so well and we start feeling a conflict between what we understand and what is happening to us.

The nature of pain

Pain is complex and not easily classified, but it is helpful to think of it in terms of acute or chronic pain for the purpose of understanding what’s going on. Only then is is possible to move on to a better realisation of the situation and to start to plan the long-term management of your life.

Acute pain

What is acute pain? Many of us think that an acute pain is a pain which is sharp or shooting, but the technical definition is more interesting for our story.

Let’s go through what acute pain means as we need to understand that before we move on to the more complex and difficult case of chronic pain.

Acute pain is recent

This does not say anything about the severity of the pain or the injury which might be involved. A severe bone fracture or a mild headache could be acute, ie have come on recently.

What is acute pain telling us?

The message of acute pain is “Warning! Tissue damage occurring or likely, unless you take action”.

What do we do then?

Well, if you are like me, you take action of some kind, you change your behaviour. This is the point of acute pain, it is meant to force us to take action, to do something about the cause of the pain or the damage which has been inflicted.

What happens next?

The problem begins to settle down and the pain subsides, leaving us to go back to normal.

We call this a useful pain and one in which hurt equals harm. When this kind of pain occurs then damage is occurring to our tissues and therefore pain means injury, and it is useful because it protects us, warning us about dangerous activities and forcing us to take action to heal ourselves when necessary.

What happens if we can’t feel pain?

Yes, I know it’s hard to believe, but there are some people (very few) who are born without the ability to feel pain in any way. There seems to be nothing different in these people apart from their inability to feel pain. However, you would be wrong if you thought this was a good thing. No pain! How wonderful, you might think. But it’s not.

Imagine how it would be if we had to bring up children who were unable to feel pain at all. You would never know when they were ill, or had damaged themselves. If they had hurt themselves quite badly, they would keep on doing what they were doing and not take any action to rest or heal themselves. Overall, these unfortunate people have huge problems throughout their livesa do not live very long, ofter into their early twenties.

So, pain has a very important protective and survival function which keeps us alive and without which we could not grow up to be adults and do all the things we want to.

Chronic Pain

This is quite different to acute pain, and what we can say is:

Chronic pain is longstanding

It starts at some time, perhaps with an acute pain, but does not settle down and go away. So the sufferer is left with a long-term problem. Let’s go through the same process as we went through with acute pain.

What is chronic pain telling us?

It feels like it is telling us the same as acute pain, but is it? In many kinds of chronic pain, there seems to be no evidence of ongoing damage to explain why the pain remains. This seems to be an example of a useless pain, a pain without a function, an example of hurt does not equal harm. If the pain had a survival function, when we took action, then something useful would happen, like us getting better. If this does not happen, then the pain can be said to have no real use.

What do we do then?

Same answer as the last time only less satisfactory. People with chronic pain search for treatments, take medications, try all kinds of therapies and undergo investigations, all to little effect. The pain tells them to take action and promises it will be better once they have done so, but the pain does not subside and go away.

What happens next?

The problem remains no matter what the person does in an attempt to relieve it, and so, despite its promises, this pain has no real use in the world. It is a pain for which hurt does not equal harm.

The important point about this is..

Here we are, having looked at the differences between acute and chronic pain and finding them quite different. One of them is vital to our survival in the world, the other is an unwelcome and useless burden for the sufferer. It is very important to understand what kind of pain we have as this will affect all our decisions to do with our pain and our lives. If you think about chronic pain in the acute pain way there will be a conflict in your head as the two things can never fit well.

Think about acute pain. We usually know what the injury was which caused the pain, we know what structure is damaged and causing the pain now, we know how to treat it and have a high expectation that it will improve with that treatment. We know roughly how long the injury will last, when we will be able to get back to our activities and we expect to get back to normal as we were before the injury.

Compare all these things we know about acute pain with what we usually know about chronic pain. We often do not know what is causing the ongoing pain, how to treat it, how long it will last or whether we will ever get better. All the things we know about acute pain are not true when we come to chronic pain. Can you see the problem? Trying to apply the usual thoughts about pain only works if we have an acute pain, when it comes to chronic pain the acute pain model of thinking is inappropriate and leads to confusion, bewilderment and frustration.

Uncertainty

It’s not that satisfactory is it? We do not know a lot about chronic pain and it is important to be honest and say there are uncertainties. If you have chronic pain then you need to think about it in a way which gets close to what is really going on. The cause is uncertain, treatment is unclear, medication variably useful, timescale unknown, outcome likely more of the same. Does that sound too depressing? It’s not meant to, as there is much that a chronic pain sufferer can do to help themselves and pain management is and will continue to be one of the main themes on this site.


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