Acute vs Persistent Pain
You may have been directed to this site because either you have a condition that can be associated with persistent pain such as types of back pain or fibromyalgia, you are on long term pain killers or perhaps because you would like to find out more about pain. This page is about PERSISTENT, or sometimes called "chronic" pain, which is pain that is present beyond 12 weeks. It is not just an extension of acute pain - it is a different entity!
What is PAIN?: Nociception vs Pain
"When you experience an injury or hurt yourself, that perception of hurt activates chemicals and channels and is called 'nociception' - it is not the same as pain.
Nociception is what we feel when there is a perception of a harmful signal in the body. It can be modified at multiple levels in the spinal cord and brain (the nervous system).
The nociception signal pings off in different areas of the brain that deal with memory, emotion, logical thinking, fear and then give a final output message.
If that message is of perceived or actual danger and to move the body to safety, our consciousness will register it as pain. If the outcome is not considered dangerous, then there is no pain."
(Dr Ravindran, the pain free mindset)
What is chronic or persistent pain? (Modified from the Southern Health Pain Management Website)
"The word “chronic” means “persistent” or “long-term”. Many people take the word to mean “severe”, but this is not necessarily the case. However, many people who are being managed for pain over 12 weeks would describe their pain as both persistent and severe. These pain conditions often have a major impact on the lives of our patients.
Often we associate pain with injuries or illnesses. We expect the injury or illness to heal and the pain to subside. However, sometimes pain can continue after the healing has taken place – as if the pain has stayed ‘switched on’. In some cases it is hard to identify any injury or illness that has triggered the pain."
The experience of pain is the end result of a complex array of different factors, as described above. The nervous system is constantly monitoring the state of our body and its environment, and interacting with the immune, emotional and muscular system. And in certain circumstances, the combined effect of all these systems working together is to amplify or dampen the experience of pain.
So pain is all about the body’s response to what is happening. This can help us to understand why sometimes, there seems to be very little correlation between the level of tissue injury (nociception) and the level of pain and why pain levels can fluctuate considerably day to day, or moment by moment. It also helps us understand why sometimes we can have very severe pain but X-Rays, MRI scans and other investigations cannot find any structural cause.
We can also start to understand how stress, changes in mood and changes in our environment can alter the nervous system’s responses and therefore the levels of pain we feel. This is not to say that the pain is ‘psychological’ – but that stress and mood can feed into the pain experience, just as our pain will sometimes impact on our mood.
PAIN VIDEOS
These videos help to explain the biology and mechanisms of persistent pain. They all explain it from a slightly different perspective.
MANAGING PERSISTENT PAIN
When pain is persistent, different types of pain relief can be helpful and there is more information on the pain relief page.
If there is an underlying condition causing persistent pain, your medical team will try to treat this cause first, where possible.
However, living with pain can bring about a wide range of changes in a person's life. It can cause feelings of anger, hopelessness or anxiety. In managing pain we should consider physical, emotional, psychological and social aspects. If we think of all the things that can affect nocicpetion and lead to a different, amplified or dampened, experiences of pain, it would be reasonable to think about things from different angles.
The following have been shown to be helpful in managing persistent pain, regardless of the cause, and are recommended in the NHS:
- Exercise therapy and movement, especially in groups
- This can also include yoga and pilates
- Supporting Mental wellbeing including managing stress, low mood, anxiety
- This can include CBT (Cogntiive behavioural therapy) and ACT (Acceptance and commitment therapy)
- Accupuncture
- Improving sleep
- Good nutrition - real food, avoiding processed food
- Breathing exercises
- Support with previous trauma or difficult childhood experiences.
Below are some links to some local resources available to you within the New Forest PCN.
It is possible that perisstent pain may not go away completely, but there can be improvements in quality of life, even if pain remains unchanged.
SO WHAT ARE MY OTHER OPTIONS LOCALLY?
Have you been on pain medications for over 3 months?
It is time to book an appt with your GP.
After 3-6 months your body would have healed or settled as much as it is going to. Taking medication for longer runs the risk of you becoming unintentionally addicted but importantly, there may be other things you've not yet considered that could help.
Check out the website painkillersdontexist.com
PSYCHOLOGICAL THERAPY:
LOCAL PAIN MANAGEMENT SERVICES
DRUG & ALCOHOL SUPPORT
EXERCISE THERAPY (& see physical activity page)
The Pain Management Service specialises in chronic or persistent pain and helping patients to manage their long-term pain conditions in the South West Hampshire region.
THE PAIN MANAGEMENT SERVICE
This service specialises in chronic or persistent pain and helping patients to manage their long-term pain conditions in the South West Hampshire region.
Services offered:
"We offer support to people living with persistent long-term pain. Our ethos is helping you to ‘live your best life’, even though this may be in the presence of pain. For the majority of our patients’ pain is an ongoing condition they are gradually coming to terms with. We are very rarely able to cure pain, but we hope to reduce its impact on peoples’ lives. We hope to help make the pain more ‘liveable with’.
We may see learning to cope with persistent pain as a journey, and our role is often to accompany people on their journey. Many people benefit from understanding their pain better, and exploring the physiological processes that cause persistent pain. We offer support to help live with the distress and the burden that pain can cause. Some patients may benefit from learning psychological strategies to help with managing their pain.
We will also look at the impact that pain has on activity, and help you to manage your activity to get the best out of life, without unnecessarily flaring up your pain.
Sometimes, we may suggest changes in pain medication, although many people living with persistent pain find that medication is not the answer. In a small number of cases, for specific conditions, injections may be offered.
How to access their services:
If you feel you could benefit from our service, please discuss this with your GP and they will be able to refer you in to our service."
Written and Updated by Dr Helina Negusse & Dr Nichola Osborne April 2023
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Deer photography by Matt Roseveare
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