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Pain Physiology Pain Rehabilitation

Chronic v. Acute Pain

Why do I hurt all the time?

Healthy pain is like a good guardian. It keeps you from hurting yourself and teaches you to stay safe. This type of pain is called ‘acute pain’.

Unfortunately, sometimes the acute pain system becomes too sensitive and overprotective. When that happens, you perceive pain as if you were injured, even though you’re not. This unhealthy state is called ‘chronic pain’. What is injured isn’t your tissues, but the nervous system itself.

Sometimes people experience chronic pain because they have been injured. For example, breaking an arm causes immediate acute pain. Sometimes, however, the pain persists or gets worse after the bone and injury are healed. This happens in complex regional pain syndrome. The very real pain is not caused by the break, it is caused by signals in the injured nervous system becoming amplified like sound in an echo chamber.

In other cases, there is no initial injury. Pain is caused by an underlying illness or disorder. For examples, people who have migraines often experience allodynia. In allodynia, normal sensations like light or sound or gentle touch cause extreme pain. In this case the nerves and brain are over-reacting to external stimuli and reacting to them as if they were harmful.

And, of course, lots of times you get combinations of acute and chronic pain. In conditions like irritable bowel syndrome, tissue inflammation and neurological problems can both cause pain. One of the reasons it can be so hard to treat chronic pain conditions is that pain can persist even after the original problem is in control.

I’m in pain. Shouldn’t I rest?

When you hurt yourself – sprain an ankle or ache all over because you have a cold – rest is the best thing for you. Your body needs rest and time to heal. When you finish healing, your pain goes away.

In chronic pain, that doesn’t work. There is no injury to your tissues, so resting won’t help. In fact, it can be harmful. If pain becomes chronic, bedrest can cause your muscles to become weak very quickly, causing its own very real pain. Overusing over-the-counter pain killers can also lead to ‘rebound headaches’, where people experience headaches BECAUSE of the medications they are taking to reduce pain.

Spending too much time in bed can also be very isolating. Alone with nothing to think about except how you feel, it’s easy to become lonely or depressed. Anxiety can creep in too. If you start to worry about the schoolwork you’re missing or things left undone, it raises your stress level. Because emotion and pain influence each other so strongly, it is easy to get into downward spirals where pain feeds stress, anxiety, and pain and they make the pain worse.

If you start worrying that pain will get worse if you get up and get out – or if pain DOES get worse when you get up and get out – it’s easy to wind up in a really bad place.

That’s why getting moving – even if it’s just from the bed to couch – is so very important.

Spoonies” have to plan carefully to do what’s most important to them because the know they’ve only got so much energy before they need to rest.

It takes a lot of energy and discipline to get out and maintain a normal life when you’re in pain. Christine Miserandino wrote a great essay explaining what it’s like, The Spoon Theory, for her blog But You Don’t Look Sick.

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