Everyone experiences pain at some point in their life. Usually, that pain resolves after a while and we return to normal activity without much of a second thought. Sometimes, however, that pain sticks around longer than we expect it should. This pain may even linger after the time when the research would say that the tissues are “healed” and should, therefore, not cause any pain. When that happens, people begin to worry about chronic pain.
I was recently able to sit down with a Dave Candy, DPT from More 4 Life PT to have a discussion on his podcast, St. Louis Pain Expert Podcast to talk about the difference between chronic and acute pain. Below, I’ll share some of the questions that we discussed on the podcast.
Here’s the video, if you want to get the full details:
How can I tell if I have acute pain or chronic pain?
Most of us experience pain at some point or another in the course of our daily lives. When pain sticks around a little bit longer than we would like, however, it’s easy to begin to worry about chronic pain. So that begs the question: When should we begin to worry about pain? What is the difference between acute and chronic pain?
What is pain?
definition of pain be revised to “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,” [1].
How would you define chronic pain as compared to acute pain?
Acute – something with sudden onset, related to a specific event (example, fracture, surgery, injury)
Chronic – something that may have started out as acute, but has lasted longer than the typical timeframe for normal tissue healing; generally 3-6 months
Is chronic pain a disease?
Chronic pain has been defined as a disease process, with various etiologies or causes. It also can be classified into three main types of chronic pain.
1. Central sensitization
is defined as an amplification of neural signaling within the central nervous system that elicits pain hypersensitivity. Or “an increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input”
2. Nociplastic Pain
Nociplastic pain is defined by the IASP as “pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain”
Defining Neuroplastic/Nociplastic Pain
The IASP clinical criteria for nociplastic pain of the musculoskeletal system imply that, in order to clinically classify nociplastic pain, patients have to:
- report pain of at least 3 months duration;
- report a regional rather than discrete pain distribution;
- report pain that cannot entirely be explained by nociceptive or neuropathic mechanisms;
- show clinical signs of pain hypersensitivity (i.e., evoked pain hypersensitivity phenomena such as static or dynamic mechanical allodynia, heat or cold allodynia, and/or painful after-sensations after any of the mentioned evoked pain hypersensitivity assessments) that are at least present in the region of pain. [2]
3. Neuropathic pain
Resulting from a lesion or disease process in the somatosensory system. This results from something going on in the nerves. Maybe it’s a nerve entrapment or maybe it’s a lesion on the nerve. Maybe there’s a physical structure pressing on the nerves.
Can chronic pain cause depression?
There has been some evidence to suggest that the experience of chronic pain may actually alter the chemical makeup (and even structure) of the brain, making the person at a higher risk for negative affective states such as depression. For example, the limbic system (amygdala) is associated with affective response to pain and also regulates emotional and motivational responses [3].
How do interpersonal relationships affect chronic pain?
Studies have shown that interpersonal relationship, social connectedness and social acceptance help improve clinical outcomes and aid in recovery and management of chronic pain [4].
Sometimes when people have chronic pain with no obvious causes, they get told that they’re making it up or that its “all in their head”. Is that true?
I get this a lot in the clinic and I would get it a lot when I was at the VA. Someone would come in and they’d say something along lines, “Well X-rays were negative.” And they are very distraught because the X-rays were negative. One of two things typically happen with these patients. The patient either believes themselves that they’re making this up or the worst effect would be a clinician telling that patient that, “Well, there’s no reason for you to be in pain because your X-rays are normal.”
Going back to this definition of pain, it is an emotional and physical experience that is in response to a tissue threat, whether that threat is real or not. So, regardless of whether there is real tissue damage happening or that threat of tissue damage is real, or not, the pain that you are experiencing is real.
Pain is always real.
Because again pain is an alarm signal. It’s your It’s like your body’s check engine light if you would and you need to, you need to explore that. Even if the easy reason that you might be experiencing that check engine light isn’t the reason for it being on, right? So it’s the same type of thing that just because you can’t point to something very not superficial that sounds bad, but something like an X-ray and say, That’s why I’m having pain doesn’t mean that your pain isn’t real. In fact, it is very real.
There are some schools of thought that all pain is created in the brain. Is that true? Can the brain really fix chronic pain?
While the brain is responsible for our pain response and perception, we can’t always assume that it’s “all in the brain”. Assuming the somatosensory system is working properly, then there should be a reason for the pain? Pain is your body’s way of telling you something is wrong, potentially wrong, or going to be wrong (check engine light).
Let’s talk about expectations with chronic pain
If someone’s had chronic pain for at least 3 months, and they go from doctor to doctor and still can’t get a diagnosis, what does that mean? Can chronic pain be cured or will they have to live with the pain forever?
While I can’t answer that for everyone, it depends on the type of pain (neuropathic, vs nociplastic, vs central sensitization). There is a chance that they will need to “self-manage” that pain in perpetuity, and there’s also a chance that it does away. The brain and nervous system are very complex, and we don’t even know all the ins and outs of it. What I tell patients is that, our brain is constantly changing from the moment we’re born until the moment we die. Neuroplasticity (or the ability of the brain to change, rewire, etc.) means that there’s always hope that we can “retain” the nervous system so that chronic pain is “cured”, but that is going to look different for every person.
For people listening who may have chronic pain, what are some actionable steps they can take toward healing it?
Biggest step would be to realize that your pain is real. Regardless of what has shown up on x-rays or MRIs. There are some practical day to day things you can try, like deep breathing, mindfulness, and/or somatic tracking (and movement -best pain medication). And then, try to find ways to continue to pursue those meaningful activities (purpose); then, find yourself a clinician who understands this topic; one that has treated individuals with chronic pain and whom you feel comfortable with. Understand that it’s a process, and there’s never really a silver bullet to rid yourself of chronic pain forever. It takes time, practice, and acceptance.
What closing message would you like to leave listeners with?
If you’re in chronic pain, do not let discouragement get you down. I like to say that we’re all one or two decisions away from a radically different life, and that’s true of our health and pain as well. We’re one or two small decisions away from putting ourselves on a path towards long-term recovery and healing, you just need to know where to step. That’s where someone like a specialized clinician comes in.
Summary
Chronic pain is no joke. Many people experiencing chronic pain find themselves at a loss for treatment options. Many times, people feel like they don’t know what else to try. If that’s you, you’re not alone. Long-term recovery and management of pain is possible. You just need to find a clinician that can help guide you on that path. If you’re in the Augusta, GA area, schedule an appointment with us at ProActive.
You can also check out our articles, videos and resources to help you on your road to recovery.
References
[1] Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, Keefe FJ, Mogil JS, Ringkamp M, Sluka KA, Song XJ, Stevens B, Sullivan MD, Tutelman PR, Ushida T, Vader K. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020 Sep 1;161(9):1976-1982. doi: 10.1097/j.pain.0000000000001939. PMID: 32694387; PMCID: PMC7680716.
[2] Nijs J, Lahousse A, Kapreli E, Bilika P, Saraçoğlu İ, Malfliet A, Coppieters I, De Baets L, Leysen L, Roose E, Clark J, Voogt L, Huysmans E. Nociplastic Pain Criteria or Recognition of Central Sensitization? Pain Phenotyping in the Past, Present and Future. Journal of Clinical Medicine. 2021; 10(15):3203. https://doi.org/10.3390/jcm10153203
[3] Yang S, Chang MC. Chronic Pain: Structural and Functional Changes in Brain Structures and Associated Negative Affective States. International Journal of Molecular Sciences. 2019; 20(13):3130. https://doi.org/10.3390/ijms20133130
[4] Meredith Kinney, Jasmine Seider, Amanda Floyd Beaty, Kaitlin Coughlin, Maximilian Dyal & Derek Clewley(2020) The impact of therapeutic alliance in physical therapy for chronic musculoskeletal pain: A systematic review of the literature, Physiotherapy Theory and Practice, 36:8, 886-898, DOI: 10.1080/09593985.2018.1516015
