How Treatment for Chronic and Acute Pain Should Differ

I had previously written about the distinction between illness and disease and why that distinction is an important one to make. I want to now apply that distinction to chronic pain.

Defining Chronic and Acute Pain

I would argue that acute pain is related to disease, and chronic pain is related to illness. Pain as defined by the International Association for the Study of Pain (IASP) is: “an unpleasant sensory and emotional experience associated with actual or potential tissue damage…”. Chronic pain is typically differentiated from acute pain based on its persistence. Generally, pain that persists beyond the expected period of time for tissue to heal following an injury or surgery is considered chronic pain. The time frame for expected healing varies, but it is generally seen as being from three to six months. So, when we have tissue damage, we experience acute pain. When the damage is healed and the pain persists, we have chronic pain. The typical medical interventions for healing acute pain, surgery or medications, are rarely useful in treating chronic pain. Because of the emotional component involved in pain as defined above by the IASP, psychological approaches that are useful in managing pain are most useful in dealing with chronic pain, but can also be helpful in dealing with acute pain.

An Interdisciplinary Approach to Treatment

It is becoming more recognized that chronic pain demands an interdisciplinary approach. There is a place for analgesics, but reliance on less or non-addictive medications is emphasized. A problem with the opioid medications used to treat acute pain is that, across time, the body builds up a tolerance to the medication, so more is needed to reduce the pain experience. With increased time and increased dosages the risk of addiction increases, and we are hearing more and more of people becoming addicted to their pain medication and the difficulties associated with that. These are simply not medications that should be a first choice in dealing with chronic pain; an alternative approach to these medications is most appropriate.  In addition to analgesics, the multidisciplinary approach also involves physical therapy, behavioral therapy and psychological therapy. This approach addresses pain management at the molecular, behavioral, cognitive –affective, and functional levels. These approaches have been shown to lead to superior and long-lasting subjective and objective outcomes including pain reports, mood, restoration of daily functioning, work status, and medication or health care use.

What We Offer

Sadar Psychological and Sports Center offers the behavioral and psychological pieces of this alternative approach. In addition, we offer a biofeedback piece that is an additional way to alter the physiological and neurological mechanisms that underlie the persistence of the chronic pain or lessen the intensity of the experience of acute pain. By lessening the intensity of the pain experience, healing is promoted and recovery from surgery or other acute pain can be facilitated. Chronic pain can be avoided.

In Summary

In general the take away message is that modern western medicine is a place to look for the alleviation of acute pain. One may want to consider other multidisciplinary approaches when dealing with acute pain to facilitate recovery and possibly to avoid reliance on potentially addictive medications. When the pain is chronic, typical modern medical approaches (i.e., surgery, medication) are probably not the methods of choice, in my opinion. Research is showing that a multidisciplinary approach including psychology and physical therapy is the way to go. I would add that biofeedback can also add a very useful component to managing and recovering from chronic pain.

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