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What the difference between acute and chronic pain?

 

Chronic Pain

 

How is pain defined?

Pain is an uncomfortable feeling and/or an unpleasant sensation in the body. The presence of pain often is an indication that something is wrong. Pain can appear suddenly or can come about slowly.

Each individual is the best judge of his or her own pain. Feelings of pain can range from mild and occasional to severe and constant. Pain can be classified as acute pain or chronic pain.

What is chronic pain?

Tens of millions of Americans suffer from chronic pain -- pain that lasts longer than six months. Chronic pain can be mild or excruciating, episodic or continuous, merely inconvenient or totally incapacitating.

With chronic pain, signals of pain remain active in the nervous system for weeks, months, or even years. This can take both a physical and emotional toll on a person. 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 personís ability to return to normal work or leisure activities.

Common chronic pain complaints include:

Chronic pain might have originated with an initial trauma/injury or infection, or there might be an ongoing cause of pain. However, some people suffer chronic pain in the absence of any past injury or evidence of body damage.

What Are the Symptoms of Chronic Pain?

The symptoms of chronic pain include:

  • Mild to severe pain that does not go away
  • Pain that may be described as shooting, burning, aching, or electrical
  • Feeling of discomfort, soreness, tightness, or stiffness

Pain is not a symptom that exists alone. Other problems associated with pain include:

  • Fatigue
  • Sleeplessness
  • Withdrawal from activity and increased need to rest
  • Weakened immune system
  • Changes in mood including hopelessness, fear, depression, irritability, anxiety, and stress
  • Disability

Chronic Pain - Treatment Overview

Treating chronic pain can be challenging. Often the reason for the pain is not clear. And it may take several types or combinations of treatments before you find relief. When treatment is started, some people may have increased pain because their chronic pain has caused them to be inactive and they have lost strength and flexibility. But over time treatment should reduce the pain and increase your ability to function. You may learn new ways of doing ordinary tasks to reduce pain. Often chronic pain cannot be cured, but it can be managed well enough to significantly improve the quality of your life.

Be sure to seek treatment if your pain lasts longer than 2 to 3 months. Early treatment may prevent the pain from getting worse.

Initial treatment

The goals of treatment are to reduce chronic pain and increase your ability to function. This includes improving your sleep and coping skills and reducing stress so you can return to your regular activities. Initial treatment depends on what kind of pain you have and how severe it is, as well as whether your pain is related to an illness, injury, or an unknown cause. Often, the best approach is a combination of therapies.

You may be able to control your pain at home by:

  • Making exercise (such as walking or swimming) a routine part of your life.
  • Eating a balanced diet. This includes getting enough vitamins such as vitamin B and vitamin D. Talk to your doctor or a registered dietitian about a healthy diet for you.
  • Getting enough sleep.
  • Using pain relievers-such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, for example) or aspirin. Always take these medicines exactly as prescribed or according to the label. Do not take a nonprescription NSAID for longer than 10 days without talking to your doctor.
  • Using complementary therapies, such as acupuncture or meditation.

A licensed mental health counselor, psychologist, or psychiatrist can help with your emotional well-being while you are dealing with chronic pain. It is common to respond to chronic pain with feelings of frustration, depression, anxiety, fear, and even anger. These feelings can make it tough to conquer chronic pain, especially if you use alcohol or drugs to manage your symptoms. Pain affects both your physical and emotional well-being. Untreated depression or anxiety can make your pain worse. A counselor may use treatments such as cognitive-behavioral therapy to help you cope with your pain.

Ongoing treatment

It is important to build a clear treatment plan for chronic pain with your doctor. Part of this plan includes identifying ways for you to manage your pain. Only you know the severity of your pain and how it affects your life. Be sure to ask your doctor if you are not clear about what steps you can take when pain occurs or gets worse.

Medicines or a combination of medicines and other therapies may be used to relieve pain, inflammation, depression, and sleeping problems that are linked to chronic pain.

If you continue to experience chronic pain, you may be:

  • Referred to one or more doctors who specialize in rehabilitation and pain management (such as an anesthesiologist, a neurologist, or a physiatrist)
  • Offered electrical stimulation therapies (such as TENS), which seem to decrease the feeling of pain for some people.
  • Given injection therapy (such as corticosteroids), which can sometimes reduce nerve pain or pain and inflammation.

For some people, complementary therapies can help reduce chronic pain. The best approach is usually a combination of treatments. If one treatment has stopped working, another treatment or combination of treatments may help reduce your pain. Try to stay ahead of the pain: don't wait until your pain is severe to begin treatment.

Treatment if the condition gets worse

If your chronic pain is not relieved after you have tried numerous treatments, you may want to think about going to a pain management clinic. Treatment is provided by a team of doctors who work together to address all the factors that may cause your chronic pain.

Treatments that are commonly used for prolonged chronic pain include:

  • Physical therapy, which may include using hot and cold therapy to relieve painful areas of the body, and exercises to maintain strength, flexibility, and mobility.
  • Transcutaneous electrical nerve stimulation (TENS), which uses a wire in a skin patch to apply brief pulses of electricity to nerve endings in the skin to relieve pain.
  • Professional counseling, such as cognitive-behavioral therapy. Stress and depression may contribute to or occur as a result of chronic pain. It is important to be healthy emotionally as well as physically to recover from chronic pain.

You may also wish to consider surgical options for relieving chronic pain.

Considerations

Your chronic pain may improve more if you have a combination of treatments at the same time.

It is important to find a doctor with whom you feel comfortable, and to keep in regular contact with this doctor. If your doctor is unable to provide effective treatment to reduce your pain, ask about a referral to a pain management clinic. There, a team of doctors can help you set realistic expectations and identify treatment choices.

Chronic Pain - Surgery

Surgery is not often used to treat chronic pain. The decision to have surgery depends on your condition and the cause of your pain. Surgery is usually considered only after other treatments have failed or if it is considered medically necessary.

Surgery may provide pain relief, but it also may permanently damage your ability to perceive other sensations, such as light touch and temperature changes. It can also cause a different pain to occur.

Surgery Choices

The most common, effective implanted pain control systems include:

  • Intrathecal drug delivery. An intrathecal pain pump is a small tube inserted in the spinal canal where the pain signals go to the brain. This tube is connected to a small reservoir of medicine inserted under the skin of your belly. The medicine is regularly delivered to the area of pain through the tube.
  • Spinal cord stimulation. Spinal cord stimulation (SCS) is a procedure that uses an electrical current to treat chronic pain. An electrical generator is put under the skin. This generator sends electrical pulses to a certain area of the spinal cord through electrodes placed in the spinal cord by a specialist.
  • Radiofrequency ablation (also called radiofrequency lesioning) is a procedure that can disrupt the flow of pain signals. First, you will need to have a test that uses a nerve block, which numbs specific nerves, to help your doctor find the nerves that are causing your pain. Then the doctor places an instrument under your skin through which electrical stimulation heats the surrounding tissue. The heat "stuns" your nerves, blocking them from sending pain signals to your brain.
  • Chemical sympathectomy. Sympathectomy prevents the flow of pain signals. In chemical sympathectomy, the malfunctioning nerve or nerves are destroyed with chemicals, usually stopping or reducing the pain. This procedure, though, may also destroy other sensations besides pain or create other sensations such as burning or numbness. This treatment may be used for a type of chronic pain called reflex sympathetic dystrophy, which is a condition that affects the nervous system. This procedure is not commonly done, because it can cause side effects that include new pain and sweating. Your doctor may want to try a sympathetic nerve block first, in which local anesthetic is injected into the nerve to relieve pain.
  • Decompression is another type of surgery used for nerve pain, such as from trigeminal neuralgia. The doctor makes an incision, and then tries to move away blood vessels or other body structures that are pressing on nerves and causing pain.

Considerations for Surgery

Surgically implanted devices are not commonly used to treat chronic pain. They may not always control chronic pain in the long term and can lead to other problems that can complicate chronic pain or sometimes make it worse.

 

 

 

   

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