ACUTE AND CHRONIC

PAIN

Sukunath B A
PGDYT 2017-18 (Evening)
PAIN
 Pain is an unpleasant sensory and emotional
experience associated with actual or potential
tissue damage, or described in terms of such
damage. (definition by IASP)
 In medical diagnosis, pain is regarded as a
symptom of an underlying condition.
 The intensity of the response to a pain stimulus
is largely subjective.
 Our individual pain perception can vary at
different times, even in response to the identical
stimulus
CLASSIFICATION- ACUTE &
CHRONIC
 ACUTE PAIN
 sudden onset
 usually the result of a clearly defined cause such as
an injury.
 sharp in quality.
 usually does not last longer than six months.
 resolves with the healing of its underlying cause.
 Causes-
 surgery,
 broken bones,
 dental work,
 burns or cuts,
 labour and childbirth etc.
CLASSIFICATION- ACUTE &
CHRONIC
 CHRONIC PAIN
 persists for weeks or months
 usually associated with an underlying condition (e.g.
arthritis)
 usually lasts longer than six months.
 can continue even after the injury or illness that
caused it has healed or gone away. Pain signals
remain active in the nervous system for weeks,
months, or years.
 Some people suffer chronic pain even when there is
no past injury or apparent body damage.
 The severity of chronic pain can be mild, moderate, or
severe.
CLASSIFICATION- ACUTE &
CHRONIC
 CHRONIC PAIN- linked to conditions like:
 Headache
 Arthritis
 Cancer
 nerve pain
 back pain
 fibromyalgia pain etc
COMPARISON
 Acute and chronic pains are different clinical entities.
 Acute pain is provoked by a specific disease or injury, serves a useful
biologic purpose, is associated with skeletal muscle spasm and
sympathetic nervous system activation, and is self-limited.
 Chronic pain, in contrast, may be considered a disease state. It is the
pain that outlasts the normal time of healing, if associated with a
disease or injury.
 Chronic pain may arise from psychological states, serves no biologic
purpose, and has no recognizable end-point.
 The therapy of acute pain is aimed at treating the underlying cause
and interrupting the nociceptive signals. The therapy of chronic pain
must rely on a multidisciplinary approach and should involve more
than one therapeutic modality.
 People who have chronic pain can have physical effects that are
stressful on the body. These include tense muscles, limited ability to
move around, a lack of energy, and appetite changes. Emotional
effects of chronic pain include depression, anger, anxiety, and fear of
re-injury. Such a fear might limit a person's ability to return to their
regular work or leisure activities.
TYPES OF ACUTE AND CHRONIC PAINS
 NOCICEPTIVE PAIN
 pain from physical damage or potential damage
to the body.
 E.g: pain felt from damages to muscles or bones such
as bruises, cuts, fractures, burns, a dental procedure,
or arthritis, cancer and surgery.
 Pain reduces once the injury heals.
 most common type of pain people experience.

 develops when the nociceptive nerve fibers are

triggered by inflammation, chemicals, or physical
events,
 such as stubbing a toe on a piece of furniture.
TYPES OF ACUTE AND CHRONIC PAINS
 usually acute and develops in response to a specific
situation
 It tends to go away as the affected body part heals.
 E.g. pain due to a broken ankle gets better as the ankle
heals.
 specialized nerve cells called nociceptors detect
noxious stimuli or things that could damage the body(
extreme heat/cold, pressure, pinching, and chemicals)
 These warning signals are then passed along the
nervous system to the brain, resulting in nociceptive
pain.
 happens very quickly in real time,
 thats is why people know to remove their hands if they
touch a hot oven or take the weight off an injured ankle.
 The information provided by nociceptive pain can
help the body protect and heal itself.
TYPES OF ACUTE AND CHRONIC PAINS
 NEUROPATHIC PAIN
 develops when the nervous system is damaged or
not working properly due to disease or injury.
 characterised by a burning, tingling or stabbing
sensation.
 last for long period of time, even after the injury
has healed.
 it does not develop in response to any specific
circumstance or outside stimulus
 individuals can suffer from neuropathic pain
even when the aching or injured body part is not
actually there- phantom limb pain, (in people
after they have had an amputation)
TYPES OF ACUTE AND CHRONIC PAINS
 also referred to as nerve pain and is usually
chronic.
 Many different conditions and diseases cause
neuropathic pain, including:
 Diabetes
 multiple sclerosis
 Stroke
 Cancer
 Cytomegalovirus
 amputation etc.
TYPES OF ACUTE AND CHRONIC PAINS
 PSYCHOGENIC PAIN
 Pain usually occurs due to tissue or nerve
damage, but increases and is prolonged because
of stress, fear, anxiety or depression.
 People with long-term pain frequently display
psychological disturbance, with elevated scales of
hysteria, depression and hypochondriasis (the
"neurotic triad").
 When long-term pain is relieved by therapeutic
intervention, scores on the neurotic triad and
anxiety fall, often to normal levels.
TYPES OF ACUTE AND CHRONIC PAINS
 BREAKTHROUGH PAIN
 transitory acute pain that comes on suddenly and
is not alleviated by the patient's regular pain
management.
 It is common in cancer patients who often have
background pain that is generally well-controlled
by medications, but who also sometimes
experience bouts of severe pain that from time to
time "breaks through" the medication.
 characteristics of breakthrough cancer pain vary
from person to person and according to the cause.
 Management of breakthrough pain can entail
intensive use of opioids, including fentanyl.
ICD CLASSIFICATION OF CHRONIC PAIN

 IASP defines chronic pain as pain with no

biological value, that persists past normal tissue
healing.
 ICD suggests 7 categories for chronic pain.
 1. Chronic primary pain: defined by 3 months of
persistent pain in one or more anatomical regions
that is unexplainable by another pain condition.
 2. Chronic cancer pain: defined as cancer or
treatment related visceral, musculoskeletal, or
bony pain.
 3. Chronic posttraumatic pain: pain lasting 3
months post trauma or surgery, excluding
infectious or preexisting conditions.
ICD CLASSIFICATION OF CHRONIC PAIN

 4. Chronic neuropathic pain: pain caused by

damage to the somatosensory nervous system
damage.
 5. Chronic headache and orofacial pain: pain that
originates in the head or face, and occurs for 50%
or more days over a 3 months period.
 6. Chronic visceral pain: pain originating in an
internal organ.
 7. Chronic musculoskeletal pain: pain originating
in the bones, muscles, joints or connective tissue.
PAIN MANAGEMENT
 IASP advocates- “...relief of pain should be recognized
as a human right, that chronic pain should be
considered a disease in its own right, and that pain
medicine should have the full status of a medical
specialty.”
 It is a specialty only in China and Australia at this
time.
 Pain management-branch of medicine employing an
interdisciplinary approach to the relief of pain and
improvement in the quality of life of those living with
pain.
 The typical pain management team- medical
practitioners (particularly anesthesiologists), clinical
psychologists, physiotherapists, occupational
therapists, physician assistants, and nurse
practitioners.
PAIN MANAGEMENT
PHARMACOLOGIC INTERVENTION
 Treating the Basic Cause

 Use of medications- Pain Killers

 Acute pain- managed with medications such as
analgesics and anesthetics.
 Caffeine when added to pain medications such as
ibuprofen, may provide some additional benefit.
 Chronic
 Nonopioids- Initially recommended
 Opioids

 Alternative Medicine: Tai Chi, Acupuncture

etc
PAIN MANAGEMENT
NON-PHARMACOLOGICAL INTERVENTION
 Not a substitute for medication
 Combining non-pharmacological intervention with
medicines is the best way to get relief

1. Cutaneous Stimulation Massage- Rubbing of

skin and heat and cold
2. Thermal Therapy- Applying ice or heat
3. Transcutaneous Electrical Nerve Stimulation-
a battery-operated unit with electrodes to produce
tingling, vibrating or buzzing sensation in the area
of pain
PAIN MANAGEMENT
4. Distraction- Focussing client’s attention on
something else.
5. Hypnosis- effective in relieving or decreasing the
amount of analgesicsrequied in patients with acute
and chronic pains
6. Music Therapy- diverting attention from pain
sensation to some soothing music; an inexpensive
and effective way
PAIN MANAGEMENT- YOGA
 Relaxation Techniques- believed to reduce
pain by relaxing tense muscles that contribute to
pain
 Consists of slow abdominal rhythmic breathing
 Guided Imagery- using one’s imagination in a
specific way to achieve positive effect
 Consistsof combining slow rhythmic breathing with a mental
image of relaxation and comfort
 Yoga Nidra- brings a state of withdrawal from
bodily sensation into inner calmness and rest.