Acute vs. Chronic Pain: Differences, Treatments, Syndrome & Latest Evidence

If you experience pain, it is essential to understand it better and find the right treatment approach. The latest pain science shows that return to a satisfying life is possible.

Acute vs Chronic Pain: What is the Difference?

We all occasionally experience pain. However, acute pain differs from persistent, chronic pain. It is beneficial to distinguish between the two, so you can manage your pain according to its origin, type and length.

Firstly, “acute” is not a synonym for severe (although it can be). In medicine, acute pain simply refers to a type of pain that is usually well localized, of rapid onset and has a limited duration (less than three months). For instance, it develops if you have an accident or an illness that affects one specific area of your body, such as a muscle, bone, intestines, appendix.[3] Acute pain resolves when the injured tissues heal.

In contrast, chronic pain usually develops slowly and persists for longer than 12 weeks or constantly recurs over time.[4]

Some experts also define subacute pain which is a subset of acute pain and lasts for more than six weeks but less than three months.3

Sometimes, acute pain can become chronic. For example, poorly managed post-operative pain can turn into persistent pain that doesn’t cease for months or years after the surgery. In fact, chronic pain is more likely to develop in the presence of another site of acute pain within the body.[5] Therefore, one of the best ways to reduce the incidence of chronic pain is to prevent acute pain from occurring, or, managing it well when it does occur.

Why Do We Feel Pain?

We have pain receptors in our skin, called the nociceptors, which get activated by an injury or inflammation. They send messages via the nerve fibres to the spinal cord and brainstem. From there, the signals travel to the brain where they get evaluated and processed, so that we can respond appropriately.

Pain usually serves a purpose; it is our protective system. For instance, it can encourage you to get up and move when you start feeling sore after sitting at the computer for too long. Or, it reminds you not to do something again, such as lift a heavy load that strains your back. Pain can also tell you when some damage is being done to your body, and you need to act quickly to prevent further injury.

When Things Go Wrong

There are different types of pain, and it is not always easy to interpret the pain’s signals. Furthermore, the amount of pain you experience does not necessarily correspond to the amount of damage you (or your doctor) can see on the body and organs.

Also, the protective system can sometimes “malfunction”. For example, in some cases, the brain makes an erroneous conclusion that you are in danger when, in fact, there is no real threat. Instead of inhibiting the sensation of pain, the brain amplifies it.[6]

There is increasing evidence that pain can change the structure and function of the nervous system.[7] For instance, we now know that in chronic pain patients, the nervous system’s function gets altered, so they become more sensitive to pain. The brain develops a “memory” of chronic pain, which influences the way it experiences every new pain. In other words, over time, the body learns pain. In some people, this can cause persistent pain that can start ruining their lives.

The Context of Pain

Although many people distinguish between acute pain, chronic pain, and emotional pain, the process in the brain is very similar for all three.[8] Likely, pain resulting from an injury or a disease will also have an emotional component. And vice versa. For instance, if you get rejected in your private life, you experience pain with a strong emotional charge. At the same time, there can also be changes in your physical body, such as changes in your body tension and cellular healing.6

People experience pain in different ways, and their experience depends on various factors, including the context. For example, one experiment found that people experience the stimulus as more painful if they are told it is hot than if they are told it is cold. Study participants who thought the painful stimulus (a metal bar touching their arm) was hot, perceived it as potentially more damaging to the tissue; thus, they interpreted it with more intensity.[9] Another study also showed that if we pair the pain with a red light, we perceive it as more painful than if we pair it with a blue light.[10]

This suggests that when the brain constructs our pain experience, it relies on different sensory cues, which can alter the outcome (i.e. our perception of pain).6 To effectively deal with pain, we, therefore, need to consider not only the physical pain but also the various contextual factors and triggers.

Daily Life with Pain

Pain is considered both a symptom and a condition in its own right.[11] It has been linked to restrictions in mobility and daily activities, dependence on opioids, anxiety and depression, making it one of the major challenges of modern healthcare.1

Pain accompanies different medical conditions, such as cancer, auto-immune diseases, fibromyalgia, arthritis, nerve compression, migraines and multiple sclerosis. It is essential to find the underlying cause of your pain. However, the diagnostic process is not always straight-forward, and many people find themselves in a limbo that can exacerbate the situation. Sometimes chronic pain can lead to something called Chronic Pain Syndrome, which is a poorly defined condition where chronic pain lasts longer than 6-months and won't respond to healthcare options.

Chronic pain can be extremely taxing, affecting your physical, emotional, psychological and social health and well-being. It is often associated with:

• fatigue
• sleeping disorders
• anxiety
• depression
• nausea
• changes in appetite
• cognitive changes
• brain fog.

The symptoms and their intensity depend on a person and their unique circumstances. However, the longer the pain persists, the more likely it is you will start experiencing additional adverse effects. Therefore, it is essential to address the pain as soon as possible according to its origin and type.

Treatments for Acute vs Chronic Pain

Modern pain management models don’t focus only on tissues but include the latest science from the fields of neurophysiology, neurobiology, psychology and genetics.

Different modalities are used in pain management, including pharmacological treatment, physical therapy and psychological therapy. The approach, of course, changes when it comes to treating acute vs chronic pain and also depends on the diagnosis.

The most common pain medications include[12]:

• non-steroidal anti-inflammatory drugs (NSAIDs), including over-the-counter medications like ibuprofen
• opioids
• corticosteroids
• antidepressants
• anti-epilepsy drugs
• muscle-relaxant medications

If your pain is acute, resting the affected part of the body and applying heat or ice can be helpful, too.

Physical therapies can also be an important part of the treatment for acute and chronic pain. Most often, these include:

• manual therapy
• exercise
• traction
• electrotherapy
  

Psychologically Based Treatments for Chronic Pain

When it comes to chronic pain, psychologically-based interventions are an essential part of the treatment process. Addressing people’s fears, attitudes and beliefs, is a vital part of pain management, as well as exploring how a person understands and copes with their pain.

Some experts – including the world expert on pain, Prof. Lorimer Moseley – argue that in cases of chronic pain, it is key to understand that “your hurts won’t harm you” as this can somewhat relax the mind and stops the “over-protective” brain from producing more and more pain. Different approaches have been recommended, including4:

• multidisciplinary pain management programs
• behavioural therapies
• cognitive behavioural therapy (CBT)
• mindfulness meditation
• hypnotherapy/hypnosis

Hypnosis, in particular, has been receiving increasing attention as a holistic, evidence-based pain management technique that can be used in combination with other approaches.[13], [14]

Other Treatment Options for Pain Relief

Complementary therapies, such as acupuncture and herbal medicine, are also being used by some patients who experience pain. However, it is vital to work with a qualified and licensed practitioner.

Changes in lifestyle and diet can have a positive impact, too, and contribute to successful pain management. There are not many good quality studies on dietary therapies yet, but some approaches have an increasing evidence base. For example, omega-3 fatty acids taken as fish oil have been found to be effective in reducing joint pain.[15]

A Word from Mindset Health

Pain is an unpleasant experience, with both a sensory and an emotional component. It arises from either actual or potential tissue damage and involves different personal and contextual factors. It is important to understand there is no one-fits-all approach to pain management, and a combination of treatments is usually required.

You should know, however, that your options are not limited to painkillers. Pain is perceived as a “traumatic event” by our brain, so you need to focus not just on the tissues, but also on the neurological and psychological components of pain.

Novel therapeutic approaches that can inhibit the exaggerated nervous response are being increasingly explored. If you experience pain, you need to diagnose and treat it according to the latest medical paradigm.  However, if your pain is long-term, you might want to examine other factors, too, including your habits, thought patterns, fears, using approaches such as hypnotherapy, CBT, and mindfulness meditation.