Acute and Chronic Pain and Symptoms

Difference between Acute and Chronic Symptoms

How the human body perceives pain

The human body perceives pain through a complex process involving the nervous system. Here’s a simplified explanation:

1. Pain Detection: Our body is covered with pain receptors, also known as sensory cells. These cells are found in our muscles, internal organs, and skin1. When a part of your body is injured, these special pain receptors release chemicals called neurotransmitters2.

2. Signal Transmission: These neurotransmitters send messages along nerves to the spinal cord2.

3. Pain Perception: The messages eventually reach the brain, which processes the information and makes us aware of the pain2. The brain then sends signals to these organs or muscles to take appropriate action3.

Pain can be classified into three types based on their causes4:

• Nociceptive Pain: Caused by tissue damage. Most acute pain is nociceptive.
• Neuropathic Pain: Caused by nerve damage or dysfunction. This kind of pain often feels similar to burning, shooting, or stabbing.
• Inflammatory Pain: Occurs when your immune system activates in response to injury or infection. It can also make you more sensitive to feelings of pain.

Pain is a normal sensory signal that something might be wrong and that you should do something about it2. It’s a protective mechanism: acute pain warns us of harm and prevents us from damaging our bodies, or limits that damage4.

Deeper mechanics of pain transmission

1. Nociceptors: The transmission of pain is linked to nociceptors, which are a specialized subset of sensory neurons that mediate pain and densely innervate peripheral tissues1. Various subsets of nociceptors are further divided according to the type of stimuli (mechanical, chemical, thermal, or noxious) they respond to1.

2. Pain Mechanisms: Determining the most plausible pain mechanism(s) is crucial during clinical assessments as this can serve as a guide to determine the most appropriate treatment(s) for a patient2. Pain mechanisms can be classified as ‘nociceptive’, ‘peripheral neuropathic’, ‘central’, and ‘nociplastic’2.

3. Gate Control Theory: This theory explains how non-painful input can interfere with pain signals in the spinal cord, preventing them from reaching the brain3. If the gate is open, pain signals can pass through and will be sent to the brain to perceive the pain. If the gate is closed, pain signals will be restricted from travelling up to the brain, and the sensation of pain won’t be perceived3.

4. Pain Perception: Pain perception is multi-dimensional, where the dimensions are not independent, but rather interactive2. The dimensions include sensory-discriminative, affective-motivational, and cognitive-evaluative components2.

5. Communication: Nearly every aspect of pain management relies on communication: assessing pain and functional status, deciding on pain management goals, implementing treatment plans, and assessing the effectiveness of those plans4. The need for clear communication is especially important for noncancer pain4.

Understanding these mechanisms can help us better manage pain and develop more effective treatments. It’s also important to remember that pain is a subjective experience and can be influenced by many factors, including emotional and psychological states5.

Chronic vs Acute pain

Acute < 3-6 months Chronic >3-6 months ## Detailed analysis of chronic vs acute Chronic pain is a complex condition that’s often different from acute pain. Here’s how the body perceives chronic pain:

1. Pain Signals: When an injury occurs, pain sensors light up, sending messages via an electrical signal to the brain1. However, in chronic pain, the brain continues to receive pain signals long after the original injury or onset of pain1.

2. Sensitization: Many chronic pain conditions arise from a process called sensitization. In this process, the brain and other parts of the nervous system overreact to sensory signals, and those signals are perceived as pain2.

3. Psychosocial Factors: Chronic pain is not just a physical sensation. It’s deeply influenced by our thoughts and emotions, which can amplify the pain experience3. Negative thoughts and emotions can intensify the pain, while positive thoughts and emotions can help reduce it3.

4. Chronic vs Acute Pain: Unlike acute pain, which is a direct response to a specific injury and usually resolves once the cause is addressed, chronic pain persists beyond the initial injury and often requires a more comprehensive approach to treatment45. Chronic pain can continue even after the injury or illness that caused it has healed or gone away4.

5. Effects on Life: Chronic pain can have significant effects on our lives. It can lead to low mood, anxiety, depression, social isolation, and even financial worries6. It can also result in tense muscles, limited mobility, lack of energy, and changes in appetite4.

6. Treatment: Treatment for chronic pain often focuses on retraining the brain’s interpretation of pain signals7. This can involve a combination of medication, physical therapy, psychological therapy, and lifestyle changes4.

Remember, chronic pain is a complex condition that requires a comprehensive approach to management.

Chronic Pain Conditions Spinal Cord Changes

In chronic pain conditions, the spinal cord undergoes several changes that can amplify the perception of pain. Here’s how it happens:

1. Nociceptive-Induced Changes: Painful stimuli trigger afferent fibers in the dorsal horn of the spinal cord to release neuropeptides and neurotransmitters1. These events induce multiple inflammatory and neuropathic processes in the spinal cord dorsal horn1.

2. Modification and Plasticity of Neural Circuits: The release of neuropeptides and neurotransmitters triggers modification and plasticity of local neural circuits in the spinal cord1. This means that the neural pathways in the spinal cord can change and adapt over time, which can lead to an increased sensitivity to pain1.

3. Central Sensitization: Chronic pain can result from a process known as central sensitization2. This involves an upregulation of ionotropic and metabotropic glutamate receptors, similar to that of long-term potentiation (LTP)2. This process leads to hypersensitization within the dorsal horn of the spinal cord2.

4. Changes in AMPAR Trafficking: In the spinal cord, nociceptive-induced changes in AMPA receptor (AMPAR) trafficking determine the central sensitization of the dorsal horn3. Changes in AMPAR subunit composition compromise the balance between synaptic excitation and inhibition, rendering interneurons hyperexcitable to afferent inputs, and promoting Ca2+ influx into the dorsal horn neurons, thereby amplifying neuronal hyperexcitability3.

These changes can lead to an increased number of pain receptors, or a heightened sensitivity of existing receptors, which can result in an increased perception of pain. It’s important to note that these changes are complex and can vary greatly between individuals.

Over-sensitized

This is something that can be calmed with training

Acute vs. Chronic Pain Video

Understanding Pain in 5 minutes video

Acute Pain (New Pain)

• Tissue damage
• You know, or can see the cause or area of pain
• Reliable signal of a problem
• Pain = Harm

Chronic Pain (Old Pain)

• Tissue damage has healed
• May not be a visible injury or known source of pain
• May be in excess of physical findings, injury/disease process
• Pain intensity has increased or stayed the same over time
• Pain is no longer a reliable signal
• Hurt <> Harm # Pain Neurobiology - Chronic Sure, let’s delve into the neurobiology of chronic pain:

1. Nociceptors: Nociceptors are sensory neurons that respond to potentially damaging stimuli by sending signals to the spinal cord and brain1. These neurons play a key role in the perception of pain1.
2. Types of Chronic Pain: Chronic pain can be categorized into nociceptive/inflammatory pain and neuropathic pain2. Nociceptive pain is caused by damage to body tissue and usually described as a sharp, aching, or throbbing pain2. Neuropathic pain is caused by damage or diseases affecting the somatosensory nervous system2.
3. Pain Mechanisms: Pain mechanisms can be classified as ‘nociceptive’, ‘peripheral neuropathic’, ‘central’, and ‘nociplastic’3. Each of these mechanisms involves different biological and neurological processes3.
4. Central Sensitization: In chronic pain conditions, the nervous system goes into a state of high reactivity. This lowers the threshold for what causes pain and subsequently comes to maintain pain even after the initial injury might have healed4.
5. Neurotransmitters and Pain: The transmission of pain signals is mediated by various neurotransmitters in the nervous system. These neurotransmitters can modulate the pain signals, either amplifying or dampening the perception of pain1.
6. Role of the Brain: The brain plays a crucial role in the perception of pain. It not only interprets the pain signals, but also regulates them via descending pathways from the brain to the spinal cord1.
7. Psychological Factors: Chronic pain isn’t just a physical sensation. It’s deeply influenced by our thoughts, emotions, and even our learning history. For instance, people who are fearful of pain or who have higher levels of stress may experience more pain3.
8. Pain Management: Understanding the neurobiology of pain can help in its management. For instance, cognitive behavioral techniques can help modify the thought patterns that can alter the perception of pain3. Moreover, physical therapies and certain medications can help manage the symptoms of chronic pain3. Remember, chronic pain is a complex condition that’s influenced by an array of factors. It’s not just about the physical sensation, but also about how your brain interprets and manages that sensation3.

Response to pain

Acute Pain

• Rest/Sleep
• Avoid work, school, chores
• Avoid social interaction
• Medication/interventions
• Comfort/support ⇒ Healing ⇒ Resume function

Chronic Pain

• Rest/Sleep
• Avoid work, school, chores
• Avoid social interaction
• Medication/interventions
• Comfort/support ⇒ Deconditioning, focus on pain, poor sleep, side effects/hyperalgesia, increased stress/depression, reinforcement for pain

Effects of chronic pain/symptoms on youth

Resources from Mayo Clinic that discuss the effects of chronic pain on youth:

1. Finding Solutions for Your Teen’s Chronic Pain: This is an excerpt from the Mayo Clinic Guide to Pain Relief by Wesley P. Gilliam, Ph.D., and Bruce Sutor M.D1. It explains how pain develops, how it can become chronic, and what you can do to free yourself from chronic pain’s effects1. It also provides guidance for parents of teens with chronic pain, including how to find a healthcare professional who can help manage your teen’s pain1.

2. The Dimensions of Chronic Pain: This is another excerpt from the Mayo Clinic Guide to Pain Relief2. It discusses the three primary dimensions that make up the chronic pain experience: sensory, cognitive, and emotional2. It also explains how negative thoughts and emotions can amplify pain and make things hurt more2.

3. A Study of Long-Term Results of Pain Rehabilitation Treatment for Young Adult Patients with Chronic Noncancer Pain: This is a clinical study conducted by Mayo Clinic3. The purpose of this study is to assess the long-term effectiveness of a Pain Rehabilitation Treatment Program specifically for young adults who have chronic non cancer pain3.

These resources provide valuable insights into the effects of chronic pain on youth and how it can be managed. Remember, chronic pain is a complex condition that requires a comprehensive approach to management12.

Treatment Goals

• Address [PRC - Biopsychosocial factors](PRC - Biopsychosocial factors “wikilink”)
• Self management of symptoms
• Return to full functioning
• Increased sense of control
• Increase quality of life
• Healthy Lifestyle

Neuroplasticity

Neuroplasticity Video

Will my symptoms improve?

They can…

• Reduce things that are turning up their pain volume
• Increase things that rurn down the pain volume

Program Concepts

• Differentiate acute vs chronic symptoms
  • Respond differently
• relaxation to strengthen parasympathetic system
• Lifestyle skills (healthy sleep, eating, stress management)
• Valued activities
• Physical Activity
• Attending activities despite symptoms

Pain Behavior

Anything that communicates you are not feeling well

Social Activities

• Encouragement conversations
• Re-stablishing “norms”
  • Age-appropriate activities
  • Family contributions
  • Respect
• Respond to pain (symptoms) focused behaviors with warm nerutrality # Symptom Focused Behaviors
• Things people say or do to communicate pain or symptoms
• A focus on symptoms signals the brain and encourages ongoing symproms

Video on effects of talking about pain

Parent Response to Pain Behaviors