The Types of Pain

Acute and chronic pain are quite different. Acute pain is usually associated with a disease or injury and serves a biological purpose and is associated with muscle spasms or sympathetic nervous system activation. Chronic pain however, could be considered a disease itself. It outlasts the normal time of healing (if associated with an illness or injury), can have many sources of origin, serves no biological purpose, and can be hard to determine the point at which it will end.

What is Chronic Pain?

Chronic pain is pain that is ongoing and lasts a long time; usually from months to years. It is very subjective, so it is very hard to measure the amount of pain across individuals experiencing chronic pain. Sometimes it can originate from an initial injury or infection, or there may be an ongoing cause of the pain. Sometimes people can experience chronic pain without any identifiable cause.

There are many types of chronic pain, such as nociceptive, neuropathic, psychogenic, and idiopathic pain. Some examples for each are listed below:

Nociceptive pain is pain that is detected either in the body’s soft tissues or organs by sensory nerves called nociceptors.

• Fibromyalgia – is frequent widespread bodily pain and exhaustion, and it is common to cause concentration and memory problems
• Endometriosis – The tissue lining the uterus grows outside the uterus. The extra tissues cause inflammation that can cause scarring, adhesions and pain in the pelvic cavity.

Neuropathic pain is caused by malfunctioning nerves. Nerve disturbances result in spontaneous transmission of pain signals to the spinal cord and brain, and most commonly feels like sharp, shooting, or stabbing pains. Some people have also said it feels ‘electrical’. Some examples of neuropathic pain are:

• Phantom limb – this is experienced by as many as 80% of amputees, where they feel a sensation in their amputated limbs as though they are still there
• Sciatica – is the irritation of the sciatic nerve (which is made up of lumbar and sacral nerve roots from the spine and runs down the back of the thigh). This often feels like an electric shock pain down the leg and can bring with it numbness, tingling, and muscle weakness.

Psychogenic pain is pain caused by a psychological disorder such as depression or anxiety. Many psychological disorders have physical complications such as exhaustion and muscle aches and pains. Just because it is psychological, that does not mean the pain is not there. The pain is most certainly real; however, it may require different treatment approaches to other types of physical pain.

Idiopathic pain exists when there is no known physical or psychological cause. Just because it cannot be traced to an identifiable cause, the pain does exist, and is more common in people who have a pre-existing pain disorder.

Chronic pain is very different to acute pain in terms of treatment. For acute pain, often the treatment is around healing and recovering, whereas for chronic pain, a large part of treatment is education for the individual regarding living with and tolerating the pain, to provide a sense of acceptance. This doesn’t mean the individual has to be happy with their situation, but best help them to come to terms with the circumstances and continue with their life. However, treatment should be multi-disciplinary, and some common treatments aside from psychological intervention are:

• Analgesic drugs
• Nonsteroidal anti-inflammatory drugs
• Muscle relaxant drugs (benzodiazepines)
• Antidepressant drugs
• Steroid injections (e.g. cortisone injection)
• Transcutaneous electric nerve stimulation (TENS)
• Spinal cord stimulators
• EMG biofeedback.

All of these can have side effects, so it is best for the person to consider these strongly and the impact on quality of life these treatments could potentially provide.

Cost of Pain

The economic impact of pain is greater than most other health conditions due to its effects on rates of absenteeism, reduced levels of productivity, and increased risk of leaving the labour market. In 2009, figures suggested the number of absent workdays was estimated to be 9.9 million annually in Australia, and workdays with reduced productivity numbered roughly 36.5 million per year. Together, this elevated the productivity losses from AU$1.4 billion due to absenteeism alone to AU$5.1 billion when both absenteeism and presenteeism were included. Furthermore, pain can have a significant effect on people leaving the labour market and moving into long-term incapacity and disability. For example, the odds of quitting one’s job because of ill health have been shown to be seven times higher among people with chronic pain problems than people without.

Psychology and Chronic Pain

The role of psychology for chronic pain is to distinguish the “dirty” pain symptoms, i.e. the reaction to pain (panic, frustration, helplessness, hopelessness, life restriction, sadness, fear and anxiety, etc) from the “clean” pain, i.e. the actual pain symptoms.

Control is not the answer for chronic pain. It eventually creates hopelessness, as there are many things people can do that they think will help control pain when these don’t actually do anything for it, and more often than not will fail. The main goal is to help adjust the goalposts for the person to help them get to the goal of living with the pain.

The psychological aspects of pain range from: reducing distress and struggles, working with thinking, and behavioural pacing. Some important aspects are helping the person come to terms with the fact that hurt doesn’t always mean harm, help them reduce catastrophic and all or nothing thoughts, and guiding them through living around their pain and create more flexible and helpful thought strategies.

At Recovery Partners, our team is dedicated to providing accurate pre-employment medical assessments for a range of industries.You can find out more about our pre-employment assessments here, where you can make an online enquiry.

Alternatively, our consultants love to have a chat, so give us a call on 1300 OHS RTW (647 789).

References:

Grichnik, K. P., & Ferrante, F. M. (1991). The difference between acute and chronic pain. The Mount Sinai Journal of Medicine, 58(3), 217 – 220.

Phillips, C. J. (2009). The cost and burden of chronic pain. Reviews in Pain, 3(1), 2-5. doi: 10.1177/204946370900300102