Difference Between Acute Pain and Chronic Pain: Why It Changes How We Treat It
It’s summer and you’ve been getting out regularly to run the river trail. Then one day the thing all of us runners hate to experience happens…you twist your ankle.
The shock of the injury and pain take your breath away for a second, but you’re able to limp the rest of the way back to your car.
During those first few days, you have swelling and intermittent sharp pain that warns you not to push your ankle too hard and reminds you it’s still healing.
Fast forward about 3 months and, while you’re back to some short road runs, your ankle still feels pretty irritable and is stopping you from getting back out on the trails and running as much as you’d like to. The pain is no longer sharp, but often more of an ache or discomfort that just doesn’t feel right.
This is the difference between acute and chronic pain.
Here's how I think about helping you navigate that difference…
I blend physical therapy with coaching to treat the whole picture. This means supporting your nervous system to feel safe enough, restoring your relationship to fearful movements, and working on the tissue itself. Pain recovery is a collaboration, not something that happens to you.
In this article I’ll go into more detail to help you understand the difference between acute pain and chronic pain, common causes, diagnosis, and give you an idea of how physical therapy in Bend, OR might help you navigate that experience.
What is acute pain
Acute pain is most often described as a protective response. It signals to our brain and nervous system that we’ve experienced something that is an actual or potential threat to our survival.
The analogy often used to illustrate acute pain is:
Imagine putting your hand on a hot stove. Your nerves immediately send a signal to your brain, your brain processes the information in the context of your lived, social, and cultural experiences and results in you quickly pulling your hand away from the stove.
In most instances, we experience acute pain in the early stages of healing from an injury and as our tissue (muscle, bone, ligament, and/or tendon) heals, our pain subsides with it, generally within about 3 months depending on the injury.
What is chronic pain
When pain sticks around for more than 3 months, or beyond what we would expect for tissue healing, we tend to classify the pain as chronic.
It’s estimated that nearly 25% of folks in the United States experience chronic pain. (CDC National Center for Health Statistics)
Chronic pain is usually thought of as a maladaptive or overprotective response. Essentially, our nervous system and brain become more sensitive and begin to equate previously non-painful movements or activities with pain.
Over time this can affect the way we move through the world, impacting us physically, emotionally, and even mentally. Many folks notice a decreased tolerance to or ability to engage in their daily, recreational, and social activities and note feelings of brain fog or lack of mental clarity.
How acute pain becomes chronic pain
The transition from acute pain to chronic pain is incredibly person-dependent.
I’ll do my best to provide an overview, but know that if you’re experiencing chronic pain and you don’t see yourself in this explanation, it doesn’t mean your pain is not real. It simply means there’s more to your story and you deserve to work with a provider who will take time to understand the context surrounding your injury that may have contributed to protective responses from your nervous system.
Broadly, when we’re considering the factors that influence chronic pain, we look at the following:
Fear-Avoidance: Pain often leads to a fear of movement. This fear leads to a cascade of avoidance of movement, disuse, disability, and more pain.
Cognitive-Behavioral: Thoughts and past experiences with pain shape our behaviors and can reinforce pain-related fear.
Social Context: This includes how we saw family members deal with painful experiences or injuries, cultural beliefs related to pain and injury, workplace expectations including stressors we were experiencing at the time of injury, interpersonal relationships, and overall job satisfaction.
It’s important to note that these influences do not exist in silos, rather they’re more like a venn diagram, overlapping and interacting with each other to varying degrees.
A patient I worked with had been in pain for 15+ years and over the course of that time had become fearful of movements like twisting and forward bending because they associated these movements with pain flare-ups. Once they experienced even a small amount of pain or familiar symptoms, they described thinking “Oh, no! This is going to put me out for weeks!” In exploring the onset of their pain, they identified that it started during a period of high stress related to their workplace at the time.
In this case, we can clearly see the overlap of fear-avoidance, cognitive-behavioral, and social context as they relate to this patient's pain experience.
Working with a provider for chronic pain treatment early in your healing process can help you remember the following:
Pain is real
Pain is a protective response
Pain does not only or always equate to damage
Our bodies are resilient and designed to heal from injury
Individualized movement and exercise programming can support the healing process
You can get back to life - hobbies, recreational activities, social engagement, family interactions, work activities - without having to be pain-free
Common causes of acute pain and chronic pain
The most common causes of acute pain I see in my physical therapy practice include:
Sprains or ligament injuries
Strains or muscle tears
Overuse injuries
Tendinitis
Broken bones with or without surgery
Post-surgical pain following a rotator cuff repair, joint replacement, ACL-reconstruction, meniscectomy, or ankle reconstruction
Some causes of chronic pain I commonly see in my physical therapy practice include:
Arthritis related pain
Chronic low back, mid-back, and neck pain
Nerve related pain like sciatica
Post-surgical pain that continues past 3 months
Fibromyalgia
Chronic conditions with pain and activity intolerance as a symptom including autoimmune conditions, chronic fatigue syndrome, hypermobility, MCAS, etc
How acute pain and chronic pain are diagnosed
When diagnosing acute pain, I spend a fair amount of time talking with you to get an understanding of:
When your injury occurred
What you were doing at the time of your injury or the mechanism of injury
How your pain is impacting you or what it’s stopping you from doing and the activities you’d like to get back to
Your lifestyle including things that bring meaning and purpose to your life, your movement practices, sleep quality, and overall stress levels
Then we get into movement looking at:
Functional movement patterns like walking, squatting, and hinging
Specific joint range of motion
Strength
Soft tissue or myofascial mobility
Muscle guarding, etc.
If appropriate, I may refer you to your PCP or a specialist for further consultation or for imaging.
With chronic pain, I also spend a fair amount of time talking with you to understand:
How long your pain has been present
What factors seem to aggravate or change your pain
The context of your injury and impact of your pain physically, mentally, emotionally, and socially
What you think is causing your pain
If you’ve had treatment for your pain before coming into see me, what about the treatment was helpful and what wasn’t. I find this to be incredibly illuminating because I don’t want to repeat things that haven’t been helpful for you and also want to be able to lean into the things that you’ve already found to be supportive in your pain process.
Imaging you’ve had already and what the findings mean to you
What you think needs to be done to decrease or eliminate your pain
Things that bring meaning and purpose to your life that your pain is stopping you from doing
Next, I want to see how you’re moving functionally, so we look at your:
Walking pattern
Squat
Hinge
How you do getting up and down from the floor or chair
Breathing pattern
Posture from the lens of how you hold your body while sitting, standing, and lying down. If you’re always guarded or forcing your body to be held in a specific position, your body never gets the message that it’s safe…to relax or to heal.
Soft tissue or myofascial mobility and muscle guarding
If during your first few sessions there’s something that is not clear to me and I believe warrants further investigation, I will always communicate that with you and refer you to your PCP or specialist to make sure we didn’t miss something important.
Physical therapy treatment options for acute pain
The old adage for acute injuries was RICE - rest, ice, compression, elevation.
What we’ve learned over the years is that this approach isn’t as supportive for healing as we once thought.
We now look at treatment through the lens of relative rest, protecting the tissue that’s injured while allowing you to stay active.
Over time, we begin to intentionally expose the injured tissue to load to promote increased tissue resilience.
Manual therapy techniques including massage, myofascial release, and joint mobilizations are incorporated to help with pain and swelling and to restore range of motion and joint mobility.
Interwoven throughout are pain education, parasympathetic (rest-digest-heal-restore) nervous system support, and reminders that your body is resilient and capable of healing.
Physical therapy treatment options for chronic pain
Treatment for chronic pain is multifactorial.
When we’ve been in pain for a long time, our nervous system becomes more sensitive so the foundation of treatment for chronic pain is re-establishing safety for our nervous system.
For many of my patients with chronic pain, we start with guided “safe space” visualizations, body scans, and finding ways to support your body so that it feels safe enough to rest and relax.
Once we’ve established safety, we can begin introducing graded exposure to aggravating activities. Initially, this might be through visualization.
Just like pro athletes use visualization to improve their performance in sport, we can use visualization to “practice” pain provoking activities with the assurance that you won’t end up injured because you’re not actually doing the activity in real time.
One runner started by visualizing themselves running along the river trail getting in many reps of “running” pain-free before they ever headed for a run on the trail. The outcome? They ran 3 miles along the river with very manageable symptoms. Win-win!
Over time, as these activities become less fear inducing, we begin to re-introduce them gradually in real time.
Some other treatments I incorporate with patients include:
Movement in nature, if it’s safe and accessible, or “nature therapy” meaning taking at least 3 minutes to look out the window, listen to bird songs or music with nature sounds
Hands on therapy to help the tissue by improving myofascial mobility and supporting the nervous system
Self myofascial release to promote more easeful movement
Breathwork to support up-regulation the parasympathetic nervous system
Addressing lifestyle impacts including sleep, stress, nutrition, hydration, movement practices
Supporting patients in building self-efficacy and agency and working toward recognizing the moments of normalcy in their lives
Working in collaboration and with curiosity
Living with chronic pain
Unfortunately, I can’t guarantee that your pain will be eliminated.
But we can reframe the goal to living your fullest life even with pain or occasional flare-ups and not letting pain sideline you from the outdoor-forward Bend lifestyle you love.
For many of my patients, this comes down to pacing, energy management, proactive planning to make sure they’re supporting their nervous system and body on those days that might ask more from them, and prioritizing community and social connection, which is an important pillar in living with chronic pain.
One patient found that prioritizing daily walks outside while being present with nature and making time to connect with their closest friends created a meaningful change in their neck and upper back pain. They still experienced pain intermittently throughout the day, but it was no longer front and center and they were able to participate more fully in their life.
Where to find physical therapy in Bend, OR for acute and chronic pain
Acute and chronic pain are unfortunate parts of the human experience.
If you’re in or near Bend, OR and are navigating acute or chronic pain and want to work with a PT who will treat your pain holistically to help you get back out on the trails, you’re in the right place.
Get started by learning more about chronic pain physical therapy and holistic PT in Bend, Oregon or by getting in touch with me.
Let’s figure this out together. Schedule a free consultation here.
Disclaimer: this post is intended for informational purposes only and is not medical advice. If you are experiencing pain, it is always in your best interest to consult with your medical doctor and/or your physical therapist.
