Acute pain refers to pain that is sharp and intense in nature as opposed to diffuse and duller intensity. It comes from either a new injury or damage event, or an exacerbation (flare up) of a prior injury; i.e. re-injury. What I mean by “damage event” is that you do not have to experience an external injury such as a fall or sports accident in order to experience acute pain. It can be the result of gradual wear and tear of a joint, such as acute onset knee pain that starts the moment cartilage erodes down to the bone; or a lumbar disc that spontaneously bursts after many years of weakening.
When pain is acute, there is redness, swelling, heat and sharp pain. These are the four hallmarks of inflammation. Inflammation, while it gets negative press, is actually a life-saving, natural process when it occurs in response to tissue damage. Its purpose is to summon all the biological and biochemical agents that are necessary to limit tissue damage and initiate healing. Without going into too much detail, there are a host of biochemicals released by injured tissues and cells that (1) cause blood vessels to dilate and become more permeable, which produces swelling; (2) regulate blood clotting to stem bleeding; (3) initiate fibroblast activity—the cells that secrete fibrous, reparative tissue over the damage; and (4) summon macrophages to the area– large cells that clean up debris.
The goal of treatment during the acute phase of pain is to reduce pain intensity; reduce swelling, and stabilize the injured area to prevent aggravation. RICE—Rest, Ice, Compress, and Elevate the area– is a good guideline for managing acute pain. You need to be patient, as healing takes time; and do the things that help your body heal naturally on its own. This will determine how well your healing goes, and in some cases will mean the difference between healing 100% or developing chronic pain from the damaged tissue.
As a side note, be cautious using anti-inflammatory medications after you sustain an injury. Remember, the inflammatory process is part of the tissue healing process so you don’t want to suppress it entirely; just manage its intensity. Diligently applying cold therapy is a better option; use the NSAIDs and cortisone only when the pain is unbearable and you cannot afford to be without the use of that painful body part for very long.
The acute stage lasts 1-3 days and is followed by the sub-acute stage, which may last several weeks. During this stage, swelling subsides, fibrosis is finishing up, blood vessels are repaired and pain gradually decreases. The goal of treatment during the sub-acute stage is to introduce movement, reduce pain and enhance healing. This includes active and passive joint mobilization, massage/soft tissue work; and sometimes pro-healing modalities such as infrared, laser and pulsed EMF.
The last stage of an injury/damage event is remodeling. The newly formed tissue and fibers become more organized and stable as you move the damaged area through its normal range of motion. This can last several months, and even years. The goal of treatment during remodeling is strengthening and restoring range of motion. Therapies include joint mobilization, spinal manipulation, soft tissue work such as active release therapy; and resistance and coordination exercises such as weights, theraband, and balancing exercises.
Chronic musculoskeletal pain refers to pain that remains after an injury or damage event has gone through the acute, sub-acute and remodeling phases. Chronic pain is typically less intense and more diffuse (less focalized), and may be intermittent (comes and goes). For some people, chronic pain significantly reduces quality of life by causing impairment in the ability to engage in certain activities of daily living such as bending at the waist, lifting, and raising one’s arm above shoulder level.
Chronic pain can assume psychosomatic qualities, where the individual can actually perpetuate and even worsen the pain through his/her thoughts and beliefs; i.e. believing and accepting one’s pain to be catastrophic and life-changing. When this occurs, it negatively changes behavior in a way that inhibits pain resolution. The person becomes over-cautious and limits his/her activities to avoid pain, which promotes atrophy, weakness and loss of muscle coordination. Because of this, a standard of care for musculoskeletal pain is to encourage the patient to have a positive attitude during his recovery; continue with his everyday work and leisure activities as best he/she can, and work through the pain and try to tolerate it as the area heals, remodels and strengthens.
Is Chronic Pain a Life Sentence?
Since chronic pain has gone through the stages of healing, can it ever be resolved 100%? By definition, chronic pain is persistent, ongoing pain. But there are cases where chronic pain made a turn for the good, and totally disappeared, even after decades of pain. What is necessary for this to happen is the tissues–ligaments, tendons, muscles, or cartilage– need to have some regenerative capacity left, and those regenerative capacities need to be optimized so that the healing is enough to stop the pain generating areas. Pain that doesn’t go away at first is often a sign of sub-optimal healing. The key is to find out what is causing this; remove it, and do things to enhance your body’s ability to regenerate the damaged area such as changing your diet, doing prescribed, therapeutic exercises and even changing your mindset if necessary. Only then do you have a chance to eliminate chronic pain once and for all.
