Chronic vs Acute Pain

Written by Teo Buzas, PT, DPT

Pain does not occur in a vacuum. It occurs with people who have different levels of injury, disease, beliefs, as well as emotional and social contexts.

Most simply, acute, and chronic pain refer to the time since the pain started. It does not refer to pain intensity levels.

Acute pain is defined as less than 12 weeks.

Chronic pain refers to pain lasting longer than 12 weeks. This pain lasts longer than the known tissue healing time frames.

Acute pain is usually related to a specific injury with associated tissue damage. There are nerve receptors that are activated at/near the injury site. If you sprain your knee, the pain is typically felt around the knee.

Acute pain responds predictably according to tissue healing time frames This pain can respond well to treatment assessing the tissue source of injury and treating it accordingly.

Once pain shifts from acute to chronic, the treatment approach often also needs to shift from diagnosis and cure to a long-term approach in pain management that focuses on improving function and quality of life.

Chronic pain reflects broader issues, much like other chronic health conditions. There is increasing involvement of other nerves including the central nervous system (spinal cord and brain) and the immune systems.

It is common that with chronic pain it is not just about the physical part exclusively. There are multiple factors that contribute to the pain experience.

Research shows that once pain becomes chronic in nature (longer than twelve weeks), it is not just about the physical (1).

The recovery for chronic pain should shift the focus from finding or excluding a physical cause to identifying many possible contributors including physical, psychological, and social (2).

Because,

Many persistent non-traumatic musculoskeletal pain disorders do not have a pathoanatomical diagnosis that adequately explains the individuals pain experience and disability (3).

So, there can be a difference between acute and chronic pain. There is a struggle with chronic pain. The struggle results in greater disability, more depression, pain-related fear, and avoidance of activity.

Here is the good news: the recovery and pain can be treated very effectively, without having to identify a single “root cause.” It is very important to understand this. It will improve outcomes. It will improve health and wellness.

It has been said that people do not die from a bee sting. They die from the allergic reaction to it.

Perhaps we can think of chronic pain in a similar way.

The relationship between pain and tissue damage becomes weaker the longer the pain persists.

There is no root cause. There are multiple contributors/stressors (causes).

For successful long-term recovery, it is important for people to take part in the treatment.

Keys to successful recovery include understanding pain and addressing unhelpful beliefs understanding your experience, and understanding the best route to take with physical activity and exercise.

So,

Try to differentiate between acute and chronic pain.

This will help change how you react towards chronic pain or a flare up of chronic pain. It will help to decrease how guarded and worried you are about it. This can decrease catastrophizing (e.g. woe is me, life isn’t fair, I can’t do what I want, I can’t be active anymore etc.). These thoughts and behaviors lead to further discouragement, increase in pain and suffering, and a decrease in enjoyable activities.

Recovery and management of pain is a process. It is not always purely linear, but success can be found! A multi modal approach works well. For physical therapy this incorporates actively listening to the client, accurate assessment, education, physical activity/exercise, and lifestyle change. This approach helps people make sense of their pain and what they can do about it. It does so not by focusing on the problem. Rather shift the focus to the solution: developing and incorporating an individualized plan to achieving relevant goals.

At Bridging the Gap Physical Therapy, we are here for you. We offer full body evaluations and discuss your treatment plan. This includes your diagnosis, your goals, and the plan for getting you there. Find out more by speaking to our team today at 239-676-0546.

1. Van Wilgen CP, Keizer D. The Sensitization Model to Explain How Chronic Pain Exists Without Tissue Damage. Pain Management Nursing. 2012;13(1):60-65.
2. Fink et al. Pain psychology in the 21^st century: lessons learned and moving forward. Scand J Pain 2020; 20(2): 229-238.
3. Lewis J, O’Sullivan P. Is it time to reframe how we care for people with non-traumatic musculoskeletal pain? Br J Sports Med. December 2018;42(24): 1543-1544.