Acute vs Chronic Pain

Listen to episode 379 and review acute vs chronic pain here or from your favorite podcast player.

Pain management is a complex component of nursing care, yet it is something you will face every single day you work at the bedside. While at first glance it may seem like pain is simply asking the patient for a pain score, it is actually a multifaceted experience that varies widely from patient to patient. In general, pain is an uncomfortable sensation that lets us know that the body is experiencing illness or injury. 

It is important to understand that pain is not the same for everyone. What is painful to one person may not be painful to another and this is simply because everyone’s body and nervous system are different. This is why you might hear a patient say, “I have a high pain tolerance” or why you might notice that two patients recovering from the exact same surgery report wildly different pain levels. 

Though there are several types of pain, pain can be broadly classified into two main types – acute pain and chronic pain. This lesson provides an overview of these two types of pain and their key differences in terms of duration, quality, impact on daily life, consequences and treatment modalities. 

What is acute pain?

Acute pain is a sudden onset of discomfort or distress resulting from an identifiable injury or illness. Think of it as an alarm system that alerts you to potential or actual harm. Acute pain is typically of short duration, and resolves once the underlying cause is removed or injured tissue heals. Note that acute pain can evolve into chronic pain if pain signals don’t function properly or if the tissue heals incorrectly. For example, a broken bone that isn’t set properly could cause long-term chronic pain, even after the bone injury has been repaired.

The key characteristics of acute pain are:

• Causes: Examples of acute pain causes are surgery, injury, burns, childbirth, menstrual cramps, and broken bones. 
• Duration: Generally resolves within three to six months, but often much faster (possibly even seconds!).
• Quality: In most cases, the pain is sharp and localized but it can also be throbbing or cramping pain.
• Impact on life: Short-term disruptions can occur such as limited mobility in the case of a broken bone or injured foot. Acute pain can cause anxiety and fear, which resolves as the pain decreases. If the injury is not treated or heals incorrectly, chronic pain can result.

What is chronic pain?

Chronic pain is prolonged pain that occurs without a clear underlying cause or persists beyond the expected period of healing. In most cases, chronic pain is experienced by the individual most days of the week and lasts longer than three to six months.

The key characteristics of chronic pain are:

• Causes: In some cases there is no identifiable cause and in other cases the cause is an injury that hasn’t healed properly. Conditions that commonly cause chronic pain include arthritis, back disorders, fibromyalgia, neuropathy, cancer, autoimmune conditions, and migraine.
• Duration: Typically longer than six months and the pain can fluctuate over time without fully going away.
• Quality: Chronic pain quality can vary widely and be sharp, dull, burning and throbbing. 
• Impact on life: Can lead to fatigue, insomnia, depression, anxiety, and feelings of hopelessness. In addition, chronic pain has significant economic impacts in that it can limit an individual’s ability to work.

How is acute pain treated?

Acute pain is treated pharmacologic and non-pharmacologic modalities. Medications used to treat acute pain most commonly include opioids, NSAIDs, and acetaminophen.

Opioids – Opioid medications include morphine, fentanyl, hydromorphone, hydrocodone and oxycodone (among others). Common adverse effects of opioids include respiratory depression, constipation, orthostatic hypotension and sedation. 

NSAIDs – Nonsteroidal antiinflammatory drugs (NSAIDs) include medications such as ibuprofen and ketorolac. A key thing to know about NSAIDs is that long-term use puts the patient at higher risk for GI bleeding. In addition, they can also cause hypertension and renal impairment.

Acetaminophen – Acetaminophen is commonly used to treat mild pain, but may also be utilized along with an opioid to increase analgesic effectiveness. For example, the medication Norco is a combination of acetaminophen and the opioid hydrocodone. Note that while acetaminophen has no significant adverse effects, taking too much can cause hepatotoxicity. For this reason, acetaminophen is limited to 3 or 4 grams per day.

Corticosteroids – Though not as commonly utilized for acute pain, corticosteroids may be utilized in some cases such as after surgery to reduce postoperative pain. Note that corticosteroids cause hyperglycemia and long-term use can lead to delayed wound healing, hypertension, osteoporosis, mood swings, and increased risk for infection. Learn more about corticosteroids here.

Skeletal muscle relaxants – You are most likely to see a skeletal muscle relaxant used for acute pain after surgery, especially back surgery. A commonly utilized medication is diazepam.

Local anesthetics – Local anesthetics are often utilized after surgery to decrease opioid use. A commonly utilized medication is ropivacaine, which is infused through a catheter to “numb” the nerves in the target area. Learn about local anesthetic systemic toxicity(LAST) here.

Non-pharmacologic interventions – Non-pharmacologic interventions for acute pain include RICE (rest, ice, compression and elevation), heat, distraction, and positioning. Heat is utilized to improve blood flow, relax muscles, and reduce stiffness, while cold is utilized to decrease inflammation. For example, an ice pack may be utilized for a sprained ankle, while a patient experiencing menstrual cramps may find some relief by using a heating pad.

How is chronic pain treated?

Chronic pain management is far more complex and often relies on a multi-modal approach that includes medications from a variety of drug classes as well as complimentary therapies. In addition to the medications listed above for acute pain, medications utilized to treat chronic pain include: 

Antidepressants – Antidepressants such as amitriptyline, a tricyclic antidepressant and duloxetine, an SNRI are often used to address various types of chronic pain including back pain, fibromyalgia and neuropathic pain.

Anticonvulsants – The anticonvulsant gabapentin is commonly used to treat pain associated with postherpetic neuralgia and diabetic neuropathy. While it does not address the underlying cause, it lessens pain by changing the way the body senses pain.

Local anesthetics – Lidocaine patches are often utilized to address chronic back pain, though you definitely could see them utilized to treat acute pain as well.

Skeletal muscle relaxants – Skeletal muscle relaxants such as baclofen and cyclobenzaprine are primarily used to treat muscle spasticity but also have beneficial effects in many types of neuropathic pain. 

Corticosteroids – Corticosteroids decrease pain by reducing inflammation, edema and nerve depolarization which make them effective adjuvants for chronic bone and neuropathic pain.

Bisphosphonates – Bisphosphonates may be utilized to decrease bone pain associated with some types of cancer.

Antihistamines – Antihistamines such as hydroxyzine and diphenhydramine can reduce anxiety associated with chronic pain and may help muscular pain as well.

Botulinum toxin (Botox) – Botulinum toxin is a local medication that relieves muscle spasticity, which can contribute to migraine headaches.

Non-pharmacologic treatments for chronic pain

Non-pharmacologic approaches to chronic pain management include cognitive-behavioral therapy (CBT), physical therapy, acupuncture, spinal cord stimulators, and TENS units. 

Cognitive-behavioral therapy (CBT) – This specific type of therapy may be utilized to help the individual cope with the emotional and mental health impacts of chronic pain such as depression, insomnia, anxiety, and fatigue.

Physical therapy – Physical therapy may be utilized to improve strength and mobility. In addition, physical therapists can help the individual with pain management strategies and develop a plan unique to their specific type of pain.

Acupuncture – Studies show that acupuncture can help reduce chronic pain and that the effects can persist over time.

Spinal cord stimulation – A spinal cord stimulator is a small device that is implanted surgically. It sends low levels of electrical stimulation directly into the spinal cord to reduce or relieve pain.

Transcutaneous electrical nerve stimulation (TENS) – A TENS unit is a small device that sends low-levels of electrical stimulation to relieve pain. It differs from a spinal cord stimulator in two ways. First, it is not implanted surgically. The unit submits the stimuli through the skin (transcutaneously). Second, it does not send the signals directly to the spinal cord. A TENS unit delivers the current to nerves at the target area to relieve pain.

Pain reprocessing therapy – A newer modality, pain processing therapy utilizes a behavioral approach to reduce or eliminate pain. With this therapy, patients work with a therapist to perceive the painful sensations they experience as less threatening so that, over time, the brain essentially “unlearns” how to feel the pain.

Nerve ablation – In this procedure, nerves around the target area undergo ablation, which damages their ability to send pain signals.

TL;DR for Acute vs Chronic Pain

And overview of acute vs chronic pain, their key differences in terms of duration, quality, impact on daily life, consequences and treatment modalities. Acute pain is a short-term, protective response to injury or illness. It is usually characterized by sharp and localized discomfort that resolves as the underlying cause heals. Chronic pain, on the other hand, persists for more than three to six months and often lacks a clear cause. In addition, chronic pain significantly impacts physical, emotional, and social well-being. Effective management for each involves tailored approaches. Treatment for acute pain focuses on analgesic medication and resolving the underlying cause, while chronic pain requires a multidisciplinary, long-term strategy utilizing a variety of therapies.

Has this overview of acute vs chronic pain helped you understand this important fundamental concept? Explore more nursing fundamentals here.

_____________________________________

The information, including but not limited to, audio, video, text, and graphics contained on this website are for educational purposes only. No content on this website is intended to guide nursing practice and does not supersede any individual healthcare provider’s scope of practice or any nursing school curriculum. Additionally, no content on this website is intended to be a substitute for professional medical advice, diagnosis or treatment.

References:

360blog. (2019, June 1). The Differences Between Deep Somatic Pain And Somatic Pain. Delaware Valley Pain & Spine Institute. https://dvpainandspine.com/the-differences-between-deep-somatic-pain-and-somatic-pain/

A Train Education. (n.d.). 16. Traditional Nondrug Approaches to Pain Management. A Train Education. https://www.atrainceu.com/content/16-traditional-nondrug-approaches-pain-management

Arizona Pain and Spine Institute. (2018, September 13). 6 Strange Facts About Pain. Arizona Pain and Spine Institute. https://gotpainarizona.com/6-strange-facts-about-pain/

Beaumont. (n.d.). Types of Pain | Acute, Chronic, Radicular & More | Beaumont | Beaumont Health. Beaumont. https://www.beaumont.org/services/pain-management-services/types-of-pain

Boezaart, A. P., Smith, C. R., Chembrovich, S., Zasimovich, Y., Server, A., Morgan, G., Theron, A., Booysen, K., & Reina, M. A. (2021). Visceral versus somatic pain: an educational review of anatomy and clinical implications. Regional Anesthesia & Pain Medicine, 46(7), 629–636. https://doi.org/10.1136/rapm-2020-102084

Bonner, D. J. (2020). Adjuvant Treatments. Pain Management Doctor | Interventional Pain Management | National Pain Specialists. https://painmanagementdoc.com/adjuvant-treatments

Bryant, E. (2021, April 19). Study finds link between red hair and pain threshold. National Institutes of Health (NIH). https://www.nih.gov/news-events/nih-research-matters/study-finds-link-between-red-hair-pain-threshold

Castroman, P., Quiroga, O., Mayoral Rojals, V., Gómez, M., Moka, E., Pergolizzi Jr, J., & Varrassi, G. (n.d.). Reimagining How We Treat Acute Pain: A Narrative Review. Cureus, 14(4), e23992. https://doi.org/10.7759/cureus.23992

Cleveland Clinic. (2020, December 8). Acute Pain vs. Chronic Pain: Differences & Causes. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/12051-acute-vs-chronic-pain

Cleveland Clinic. (2023, September 25). Transcutaneous Electrical Nerve Stimulation (TENS). Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/15840-transcutaneous-electrical-nerve-stimulation-tens

Contributor, N. T. (2018, February 26). Understanding the effect of pain and how the human body responds. Nursing Times. https://www.nursingtimes.net/clinical-archive/pain-management/understanding-the-effect-of-pain-and-how-the-human-body-responds-26-02-2018/

Devitt, M. (2018, May 21). Research Finds Acupuncture Effective for Chronic Pain. AAFP. https://www.aafp.org/news/health-of-the-public/20180521acupuncture.html

Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). (2015). Adjuvant Bisphosphonates for Postmenopausal Breast Cancer – NCI. The Lancet, 386(10001), 1353–1361. https://www.cancer.gov/types/breast/research/adjuvant-bisphosphonates-meta-analysis

Fromm, G. H. (1994). Baclofen as an adjuvant analgesic – ScienceDirect. Journal of Pain and Symptom Management, 9(8), 500–509. https://www.sciencedirect.com/science/article/pii/0885392494901112

Furst, J. (2016, March 26). What does OPQRST stand for in first aid? First Aid for Free. https://www.firstaidforfree.com/what-does-opqrst-stand-for-in-first-aid/

Hummel, P., Puchalski, M., Creech, S., & Weiss, M. (2004). N-PASS: Neonatal Pain, Agitation and Sedation Scale – Reliability and Validity. Anestesia Pediatrica e Neonatale: Italian Internet Official Journal of Pediatric and Neonatal Anesthesia, 2(2). http://www.anestesiarianimazione.com/2004/06c.asp

Hyland, S. J., Wetshtein, A. M., Grable, S. J., & Jackson, M. P. (2022). Acute Pain Management Pearls: A Focused Review for the Hospital Clinician. Healthcare, 11(1), 34. https://doi.org/10.3390/healthcare11010034

Jacques, E. (2022, November 3). How Adjuvant Analgesics Are Used to Treat Chronic Pain. Verywell Health. https://www.verywellhealth.com/what-are-adjuvant-analgesics-2564529

Laconi, G., Coppens, S., Roofthooft, E., & Van De Velde, M. (2024). High dose glucocorticoids for treatment of postoperative pain: A systematic review of the literature and meta-analysis. Journal of Clinical Anesthesia, 93, 111352. https://doi.org/10.1016/j.jclinane.2023.111352

Mahmoodi, A. N., & Kim, P. Y. (2023). Ketorolac. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK545172/

MedlinePlus. (2020, May 15). Gabapentin: MedlinePlus Drug Information. MedlinePlus. https://medlineplus.gov/druginfo/meds/a694007.html

Miroshnychenko, A., Azab, M., Ibrahim, S., Roldan, Y., Diaz Martinez, J. P., Tamilselvan, D., He, L., Urquhart, O., Verdugo-Paiva, F., Tampi, M., Polk, D. E., Moore, P. A., Hersh, P. V., Brignardello-Petersen, R., & Carrasco-Labra, A. (2023). Corticosteroids for managing acute pain subsequent to surgical extraction of mandibular third molars: A systematic review and meta-analysis. Journal of the American Dental Association (1939), 154(8), 727-741.e10. https://doi.org/10.1016/j.adaj.2023.04.018

Murphy, J. L., McKeller, J. D., Raffa, S. D., Clark, M. E., Kerns, R. D., & Karlin, B. E. (n.d.). Cognitive behavioral therapy for chronic pain among veterans: Therapist manual. Department of Veterans Affairs. https://www.va.gov/painmanagement/docs/cbt-cp_therapist_manual.pdf

Nazari, R., Froelicher, E. S., Nia, H. S., Hajihosseini, F., & Mousazadeh, N. (2022). Diagnostic Values of the Critical Care Pain Observation Tool and the Behavioral Pain Scale for Pain Assessment among Unconscious Patients: A Comparative Study. Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine, 26(4), 472–476. https://doi.org/10.5005/jp-journals-10071-24154

Nugent, S. M., Lovejoy, T. I., Shull, S., Dobscha, S. K., & Morasco, B. J. (2021). Associations of Pain Numeric Rating Scale Scores Collected during Usual Care with Research Administered Patient Reported Pain Outcomes. Pain Medicine, 22(10), 2235–2241. https://doi.org/10.1093/pm/pnab110

Nursingenotes.com. (n.d.). Hot and Cold Applications in Nursing. Nursingenotes.Com. https://nursingenotes.com/hot-and-cold-applications-in-nursing/

painHEALTH. (2023, April 11). Pain Types – Pain Management. PainHEALTH. https://painhealth.csse.uwa.edu.au/pain-module/pain-types/

Piedmont. (n.d.). When to treat pain with ice vs heat. Piedmont. https://www.piedmont.org/living-better/when-to-treat-pain-with-ice-vs-heat

Portenoy, R., Ahmed, E., & Keilson, Y. (2023, August). Cancer pain management: Role of adjuvant analgesics (coanalgesics) – UpToDate. UpToDate. https://www.uptodate.com/contents/cancer-pain-management-role-of-adjuvant-analgesics-coanalgesics

Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., Keefe, F., Mogil, J. S., Ringkamp, M., Sluka, K. A., Song, X.-J., Stevens, B., Sullivan, M., Tutelman, P., Ushida, T., & Vader, K. (2020). The Revised IASP definition of pain: concepts, challenges, and compromises. Pain, 161(9), 1976–1982. https://doi.org/10.1097/j.pain.0000000000001939

Ravven, W. (1999, July 30). Surgical pain increases risk of infection, study shows. UCSF. https://www.ucsf.edu/news/1999/07/97507/surgical-pain-increases-risk-infection-study-shows

Rayvts, S. G., Emrich, M., Gnall, K., & Laumann, L. (n.d.). The Role of Mental Health in the Treatment of Chronic Pain. Society of Behavioral Medicine. https://www.sbm.org/healthy-living/the-role-of-mental-health-in-the-treatment-of-chronic-pain?gad_source=1&gclid=Cj0KCQiAu8W6BhC-ARIsACEQoDBUC9Bqs9iXx19Bklc4ARlFVElYORD8OYq1-L7ws2hez7xWONx4kWIaAsHeEALw_wcB

Republic Pain Specialists. (2020, May 17). Nociceptive Pain: Visceral or Somatic. Republic Pain Specialists – Pain Management & Parosmia Treatment. https://republicpainsp.com/resources/blog/articleid/29/nociceptive-pain-visceral-or-somatic

Rzasa Lynn, R. (2024, September 9). New Treatments Offer Much-Needed Hope for Patients Suffering From Chronic Pain. Anschutz. https://news.cuanschutz.edu/news-stories/new-treatments-offer-much-needed-hope-for-patients-suffering-from-chronic-pain

Singh, K., & Dua, A. (2023). Anesthesia for Awake Craniotomy. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK572053/

Sivanesan, E. (n.d.). Spinal Cord Stimulator. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/treating-pain-with-spinal-cord-stimulators

Solan, M. (2023, May 1). Which antidepressants are best for treating chronic pain? Harvard Health. https://www.health.harvard.edu/pain/which-antidepressants-are-best-for-treating-chronic-pain

Southern Pain and Neurological. (2021, June 25). Different Types of Pain & How They’re Treated. Southern Pain and Neurological. https://southernpainclinic.com/blog/different-types-of-pain-how-theyre-treated/

Srivastava, M., & Walsh, D. (2003). Diazepam as an adjuvant analgesic to morphine for pain due to skeletal muscle spasm. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 11(1), 66–69. https://doi.org/10.1007/s00520-002-0386-8

The Royal Children’s Hospital Melbourne. (2020, December). Clinical Guidelines (Nursing) : Neonatal Pain Assessment. The Royal Children’s Hospital Melbourne. https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/neonatal_pain_assessment/

UCI Health. (2018, April 12). Do redheads feel more pain? UCI Health. https://www.ucihealth.org:443/blog/2018/04/redheads-pain/

UPMC. (n.d.-a). Acute Pain Causes, Symptoms, and Treatments. UPMC. https://www.upmc.com/services/pain-management/conditions/acute-pain

UPMC. (n.d.-b). Chronic Pain Causes, Symptoms, and Treatments | UPMC. UPMC. https://www.upmc.com/services/pain-management/conditions/chronic-pain

UW Health. (n.d.). Patients & Families. UW Health. https://patient.uwhealth.org/healthfacts/7590

Vickers, A. J., Vertosick, E. A., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., Irnich, D., Witt, C. M., Linde, K., & Acupuncture Trialists’ Collaboration. (2018). Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. The Journal of Pain, 19(5), 455–474. https://doi.org/10.1016/j.jpain.2017.11.005

Vyvey, M. (2010). Steroids as pain relief adjuvants. Canadian Family Physician, 56(12), 1295–1297. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001922/

Walid, M. S., Donahue, S. N., Darmohray, D. M., Hyer, L. A., & Robinson, J. S. (2008). The fifth vital sign–what does it mean? Pain Practice: The Official Journal of World Institute of Pain, 8(6), 417–422. https://doi.org/10.1111/j.1533-2500.2008.00222.x

Watanabe, S., & Bruera, E. (1994). Corticosteroids as adjuvant analgesics. Journal of Pain and Symptom Management, 9(7), 442–445. https://doi.org/10.1016/0885-3924(94)90200-3

WebMD Editorial Contributors. (2023, May 4). Visceral Pain: What Causes It and How to Manage It. WebMD. https://www.webmd.com/pain-management/what-is-visceral-pain

Zane, M. K., & Thornton, L. (2024, April 28). Physical Therapy Guide to Chronic Pain. Choose PT. https://www.choosept.com/guide/physical-therapy-guide-chronic-pain

Last Updated on December 30, 2024 by Maureen Osuna, MSN, RN