Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression


chronic“The Acute/Chronic Differences”

We use the experience of pain to signal that a problem exists and must be addressed. There are those who are unable to experience pain (Eg. congenital analgesia). It is a rare disorder, although there is a village in Sweden with a high incidence of the condition. For the rest of us, acute pain is a common experience and can result from injury or disease process. It may indicate the need for palliative measures or the need for surgical intervention. In either case, we anticipate that if we address an acute pain, it will resolve, and we shall be restored to safety and comfort.

Each individual gauges his/her own pain, and that variability we refer to as “pain tolerance.” We ask the patient to quantify the magnitude and nature of the pain; for example, is it a “severe stabbing pain” or a “burning pain” etc. Since we attempt to understand the pain, we sometimes ask the patient to quantify the pain on a pain such as “1-10” or with pediatric patients, we use the Faces scale. But we have all seen patients who can ignore a heart attack to sit calmly and quietly and tell you that their shoulder pain is “definitely a ten”.

In general, we see acute pain as having a sudden onset that is usually “sharp” in nature. It warns the patient of a threat to his/her body. Acute pain might be mild and last just a moment, or it might be severe and last for weeks or months. In most cases, acute pain does not last longer than six months, and it disappears when the underlying cause of pain has been treated or has healed. Unrelieved acute pain, however, might lead to chronic pain.

Chronic pain persists despite the fact that the injury may have healed. Pain signals remain active in the nervous system for weeks, months, or years. Physical effects include tense muscles, limited mobility, a lack of energy, and changes in appetite. Emotional effects include depression, anger, anxiety, and fear of re-injury. Such a fear might hinder a person’s ability to return to normal work or leisure activities.

Thus, a patient with lumbar pain may have had the requisite care, including surgeries, but the pain persists.

In general we tend to refer to new onset pain, leading to effective treatment, as acute pain, that which is or will be resolving.

We refer to chronic pain as that for which treatment has been rendered and yet the pain persists.

Those treating pain are personally familiar with acute pain, not only in patients but in themselves. They have a good understanding of “what it feels like”.

The problem arises when dealing with chronic pain in a patient who has had all appropriate care. The treating clinician may never have personally experienced chronic pain, and there is a saturation effect when so many patients report so much pain. It becomes difficult to identify with the patient’s suffering and to help them find a means within themselves of managing what, for them, will be chronic pain of long, or lifelong, duration”.

National Institute of Neurological Disorders and Stroke. Pain: Hope Through Research Accessed 8/5/2014.



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