Pain is a normal part of life: a skinned knee, a tension headache, a bone fracture. But sometimes pain becomes chronic -- a problem to explore with your doctor. WebMD asked Eduardo Fraifeld, MD, president of the American Academy of Pain Medicine, to help readers understand acute vs. chronic pain.
How do you explain to patients the difference between acute and chronic pain?
Acute pain is normal pain that warns that you've been hurt, Fraifeld says. "When you break your leg, when you hit your thumb with the hammer, when you put your hand on the hot plate and you burn yourself … that's good pain. It tells you that you have an injury." When you touch that scorching dish, your body will react immediately and you'll pull your hand away.
Acute pain starts suddenly and usually doesn't last long. When the injury heals, the pain stops. For example, a broken leg will hurt during recovery, but "as time goes on, it gets better and better," Fraifeld says.
With chronic pain, "the pain itself becomes a disease," Fraifeld says. "When the injury heals and you continue having pain beyond the time of expected recovery, that's chronic pain."
Chronic pain lasts for weeks, months, even years. Generally, it's diagnosed after three to six months of pain. In some cases, the pain comes and goes. With chronic pain, one's nervous system is sometimes altered, making it more sensitive to pain. As a result, painful sensations might feel more severe and last longer.
Are there some medical conditions that cause chronic pain?
Yes, some chronic diseases cause chronic pain. "Arthritis is the easiest example that I can think of," Fraifeld says. Cancer, diabetes, and fibromyalgia are other diseases that can cause continuing pain
Can doctors always find the cause of chronic pain?
No. In a minority of cases, the cause is unclear. "There are cases in which you just cannot come up with an absolute diagnosis," Fraifeld says.
When should patients talk to their doctor about pain?
Tell your doctor if the pain lasts longer than reasonably expected. Some guidelines have defined "chronic pain" as pain that lasts longer than 3-6 months, but Fraifeld calls those definitions "arbitrary."
Whenever pain lasts longer than reasonably expected, it's crucial to treat it to keep it from worsening into chronic pain, he says. For example, a small cut or burn normally wouldn't cause pain after a month; if it does, call your doctor rather than waiting for three months.
People with disorders that cause chronic pain should also talk to their doctors about treatments that provide relief or help them to cope with pain. Treatments include pain relievers and other medications, acupuncture, biofeedback, relaxation training, hypnosis, distraction techniques, and transcutaneous electrical nerve stimulation. With this last method, patients use a TENS device to pass a mild electrical current through the skin to reduce pain.
When should a patient seek a referral to a pain specialist?
"Most pain is not handled by pain specialists, it's handled by primary care physicians," Fraifeld says. That's the proper starting point, he says; many primary care doctors are able to treat pain successfully. However, if your primary care doctor is unable to diagnose the cause of your pain, is unfamiliar with your type of pain, or is unsure of how to treat it, ask for a referral to another doctor who has experience with your particular symptoms or disease.
Most patients with pain don't need to see a pain specialist. But if pain lasts much longer than expected, or your primary care doctor or specialist hasn't been able to treat your chronic pain satisfactorily, ask whether a referral to a pain specialist would help, Fraifeld says.
"[Patients] should go to a physician specifically trained in pain," he adds. That way, they'll receive a medical exam to diagnose their problem, as well as proper pain management. Typically, these pain specialists come from the fields of neurology, anesthesia, psychiatry, and physical medicine and rehabilitation, according to Fraifeld. Then they undergo additional training in pain medicine.
What to avoid? Pain clinics, often run by non-physicians, that offer injections or other treatments without first doing a thorough exam to make a medical diagnosis. "Unfortunately, the propensity for this is increasing around the country," Fraifeld says.