Why Does Acute Pain Become Chronic?

April 29, 2022 / Thomas Cohn, MD

Acute pain is oftentimes the result of direct trauma to an area, but in most cases the injury can eventually resolve with the help of active treatment. However, for a small percentage of people, their acute pain turns into a chronic condition, and this can make it much harder for pain to eventually subside. But why does acute pain turn into a chronic condition, and what can you do to prevent this from happening? We answer those questions and more in today’s blog.

Acute Pain Turns Chronic

If you’re not careful, an acute injury can turn into chronic pain. Here’s a look at some of the more common reasons why acute pain eventually becomes a chronic condition.

Left Untreated – The most common reason that an acute injury turns into chronic pain is because you don’t actively treat the underlying issue. A lot of people just try to grit their teeth and push through any discomfort caused by an acute injury, but that can lead to additional stress on an area and prolonged pain. For example, if you sprain your ankle, you’ll make the best recovery with a little bit of rest, physical therapy and a slow reintroduction to physical activities. If you try to keep playing sports or working manual labor on an injured ankles, those damaged ankle ligaments may never truly heal, leading to chronic instability or similar long-term issues. Don’t leave a problem, no matter how small, untreated.

Treating The Wrong Underlying Condition – An acute injury can also lead to a chronic condition if you end up treating the wrong underlying issue. If you think you’re dealing with one injury with a specific treatment regimen, but you are actually dealing with something else that is best treated by a different set of remedies, the underlying issue may never be corrected, leading to long-term discomfort and chronic pain. This speaks to the importance of syncing up with a specialist to ensure you receive an accurate diagnosis.

Nerve Damage – If certain nerves are damaged, that can throw off off how sensory signals are sent and interpreted in the brain. You may no longer be in true physical pain, but a damaged nervous pathway could be relaying signals that the brain interprets as pain, leading to chronic discomfort. Chronic pain can be just as much psychological as it is physical.

Psychological Factors Associated With A Physical Injury – As we noted above, psychological factors can play a role in your expression and interpretation of pain signals, and sometimes our emotions can be thrown into flux following an acute injury. For example, if you were involved in a severe car accident, you may be dealing with more emotions like fear, anxiety or stress, and research has shown that these feelings can negatively affect your pain perception.

Acute pain can turn chronic for both physical and psychological reasons, so it’s imperative that you sync up with a pain specialist, get to the bottom of your issue and begin a targeted treatment problem to rid you from your acute or chronic pain. For more information, or for help with a chronic pain issue, reach out to Dr. Cohn’s office today.

The Differences In Treating Acute Vs. Chronic Pain

April 28, 2020 / Thomas Cohn, MD

Everyone experiences pain differently, and depending on the type of pain you’re suffering from, it will generally be categorized into one of two groups – acute pain and chronic pain. Acute pain is the most common type of pain, and it is typically the result of trauma. For example, if you stub your toe on the kitchen table, you’ll be feeling acute pain in your toe. Conversely, chronic pain is a type of pain that is persistent or that lasts for longer than three months. Chronic pain can develop out of acute pain, or it can develop for another reason. For example, if that same stubbed toe led to nerve damage that never healed properly, you may suffer from chronic toe pain.

Although these two types of pain are often intertwined and related, they typically need to be treated in slightly different manners. Below, we take a closer look at some of the different ways acute and chronic pain are managed.

Treating Acute Pain

We treat both types of pain at our clinic, but acute pain tends to be treated more commonly in hospitals and emergency departments. Fractures, sprains, bruises and cuts are all common forms of acute pain that result from trauma or physical injury. Although treatment should be individualized to the patient, minor to mild acute pain is often treated with conservative options like:

Rest
Anti-inflammatory medications
Pain-relieving medications
Elevation
Compression
Hot or cold therapy
Casting

For more severe forms of acute pain, options like manual therapy, physical therapy or surgery may be recommended. Most providers will recommend that you try six weeks of conservative therapy before you pursue surgery, although certain acute injuries may require more immediate surgical intervention.

Treating Chronic Pain

Treating chronic pain is a little more difficult than acute pain, because it’s not always obvious what’s causing the pain. When you stub your toe, it’s easy to hone in on suspected problems. However, if you’ve been feeling mild discomfort in your spine for the last few months and it’s progressively gotten worse, there are a number of different issues that could be contributing to your pain. Because of this, the most important aspect to developing a successful chronic pain treatment plan is to determine the underlying cause of pain.

With the help of a physical exam, movement screens and imaging tests, a chronic pain specialist can help pinpoint exactly what’s going on in your body. From there, a treatment course is charted.

Many of the same treatment options for acute pain can be applied to chronic pain, but treatment tends to focus on more of the active treatments instead of passive options like rest and medications. While those aspects can play a key role in your recovery, chronic pain oftentimes responds better to treatments like:

Physical Therapy
Exercise
Stretching Techniques
Posture Awareness and Education
Weight Loss and Improve Diet

You’re also more likely to need to adjust your treatment strategy when trying to rid yourself of chronic pain, so take note of what’s working and what’s not working and discuss these options with your doctor. Don’t just keep trying certain treatments if they aren’t producing results, because odds are a few simple adjustments can greatly reduce your pain.

For more information about either type of pain, or for help with your pain, reach out to Dr. Cohn’s office today.

A Closer Look At Acute And Chronic Pain

October 7, 2019 / Thomas Cohn, MD

Chronic pain is usually different from acute pain. Acute pain is considered to be directly related to stimulation of sensory receptors for noxious stimuli located throughout the body. It is often related to direct damage or trauma to the body. It also is the normal physiologic response to the various types of sensory receptors that is perceived as noxious or painful. Acute pain is relatively short lasting and is a direct response to direct stimulation of sensory receptors with lengths from seconds to usually less than several months. Chronic pain however is long in duration, lasting over three months and becomes independent of direct stimulation of sensory receptors for acute stimuli.

Chronic and Acute Pain

Chronic pain most often is characteristically different from acute pain. It often involves the nervous system changing on a peripheral and central basis such that sensory signals are perceived differently. In the limbs or other areas, sensory receptors become increasingly able to respond to any stimuli and then sending a signal out into the central nervous system. The nervous system essentially becomes primed for responding to sensory inputs and blasts out a powerful danger signal out of proportion to the intensity of the event. A small touch on the arm could feel like being hit by a sledgehammer.

Chronic pain is divided medically into three types;

Nociceptive
Neuropathic
Central sensitization

It can also be a combination of these. As pain becomes more chronic, the central nervous system becomes more involved and pain has more centralized components. The secondary outcomes of chronic pain over time also become prominent with increased healthcare utilization and often decreased quality of life.

There are multiple correlations in a person’s life that are associated with chronic pain. Common attributes include being female, early life trauma, family history of pain and mood disorders, genetics, sleep disturbances and mood disorders. Certain types of pain that more commonly become chronic include headaches, low back pain and fibromyalgia/diffuse myofascial pain, while the psychological factors of anxiety, depression, catastrophizing, and PTSD are linked to developing chronic pain.

Well-managed and aggressively treated chronic pain comprehensively reduces the incident of chronic pain, but as pain continues ongoing aggressive management can impact the intensity of long-term issues. It is important to treat all aspects of a painful condition. Often there are multiple factors stimulating pain and all the physical problems need to be addressed from muscles, nerves, tendons, ligaments, joints, bones and any other system involved as well as the psychological impacts.

Comprehensive management of symptoms is one of the keys to successful outcomes. Using traditional medical strategies including medications and physical therapy in conjunction with techniques like acupuncture, meditation and improving sleep hygiene may all be necessary in managing pain. Aggressive management of acute pain, especially traumatic or post-surgical, helps reduce the incident of the development of chronic symptoms.

Acute pain is a common arena for most regular physicians. Comprehensive initial management of acute painful conditions reduces the development of more chronic problems. If the pain is showing tendencies toward becoming chronic, involvement of a pain specialist can reduce the impact of the long-term symptoms.

Low Back Pain – A Common Problem, often Mistreated

July 31, 2013September 27, 2016 / Thomas Cohn, MD

Low back pain is a very common issue – 85% of the population will experience back pain at some point in their lives. However, back pain is often treated improperly and as a result, it has become a costly problem in American society. A lack of understanding of back pain, its causes, and usual treatment, leads to costly management.

Acute Low Back Pain

Acute low back pain is pain that has been present less than 3 months. Most back pain can be treated conservatively. Only rarely is back pain a serious medical emergency. There are many structures in the back that cause pain, including:

Vertebral discs
Bones
Joints
Nerves
Muscles

All of these can cause pain. Fortunately, most pain is caused by muscle strains and irritation of joints, discs or nerves. Initially all of these are treated the same, with ice and heat, minimal rest, stretching, and then muscle strengthening of the core.

Medications should be kept simple – use Tylenol or anti-inflammatories like naproxen to manage the pain. If pain is more severe, see a primary care physician for referral to a Physical therapist. Very short-term use of narcotic pain medicine is useful if other medications cannot be taken but these are not advised for more than several weeks.

If Back Pain Persists

If back pain persists for more than a month, despite basic management, you should seek out an expert in low back pain. The best medical doctors to evaluate and treat this type of pain are board certified physicians in Physical Medicine and Rehabilitation. These physicians are experts in the musculoskeletal and nervous system. They can guide a person through a detailed exam and diagnosis and more advanced treatments.

Surgery, MRIs, & CT Scans

Back pain is rarely a medical emergency. If a patient has had cancer and has new onset of back pain, aggressive evaluation is necessary to determine if cancer is affecting the region. Low back pain with loss of control of the bowels, or loss of muscle function in the legs is the other case when aggressive evaluation is necessary.

Back pain is usually relatively benign. Most pain will resolve within weeks with conservative treatment. Only in rare cases (such as cancer) should MRI or CT scans be obtained.

Surgery should only be considered if nerves are compromised, or bowel or bladder control is lost due to the spine being injured.

How the Body Feels Pain

July 8, 2013September 27, 2016 / Thomas Cohn, MD

Pain is a complex issue. Acute pain is usually related to one of the following:

Tissue damage
Perceived damage
Injury

Chronic pain can be associated with chronic damage or a short circuit in the transmission of pain signals. Treatment of pain depends on the cause. In acute pain, if you treat the cause the pain will normally go away. However when pain becomes chronic, treatment often does not take away all the symptoms.

Pain Signals & Sensory Stimuli

Chronic pain is generally defined as pain lasting longer than 3 to 6 months. Often, it outlasts the initial injury. In some ways it becomes independent of the initial stimulus or cause. Damage may be ongoing, and there may be a chronic inflammatory response, all causing ongoing sensory stimuli, which are subsequently linked in the spine and brain, to the perception of pain. Often, non-painful sensory signals then become linked to nerves that previously transmitted pain signals. Normal signals then become perceived as pain.

All sensory signals are processed in the brain at some level. The brain has an incredible ability to determine the importance of each signal and then form a response. Depending on the circumstance, the brain can ignore the same signal that would be horrific pain. For example, we all have heard about soldiers in war who have been shot, but continue fighting with no loss of focus. Therefore, the real key player in all responses to pain signals is the brain and its interpretation of the signals.

Blocking Pain Signals

The key to treatment of pain then is altering the brain’s ability or desire to interpret sensory signals as pain. Blocking signals can be done anywhere along the path from the sensory receptor including:

The peripheral nerve to the spinal cord
Along the spinal cord pathways
In the brain itself

Although pain can be treated in multiple ways, all treatments try to prevent transmission and interpretation of sensory signals that are perceived as pain. There is no magic bullet and no one treatment alone that will work for everyone.

The simple reason why there are so many treatments for pain is that there are so many ways to alter signals that are perceived as pain. Medications have been designed to affect sensory impulses at a variety of locations from the skin and periphery to the spine and brain. Furthermore, there are a variety of techniques from proper movement, to acupuncture, to psychological training that can effectively treat pain.