Acute vs Chronic Pain
Understanding Pain: Acute vs Chronic
Pain is typically categorized as either acute or chronic:
Acute pain comes on suddenly and usually has a clear cause, like a cut on your finger or a broken bone. It lasts no longer than 3-6 months and goes away as the injury heals.
Chronic pain lasts longer than 6 months. It may start with an injury but persist after the injury has healed, or it may develop without any obvious injury at all.
While these categories feel familiar, it can be even more helpful to think of pain as either primary or secondary. This distinction can guide us toward more effective treatments.
Understanding Pain: Primary vs Secondary
Let’s start with secondary pain, the concept of pain that most of us are familiar with.
Secondary pain is pain created by the brain in response to an injury in the body - for example, the pain of a cut or broken bone. Most secondary pain is acute pain.
In contrast, primary pain is pain created by the brain that is independent of any injury in the body.
There may be structural changes in the body correlated with primary pain, but these changes are not the direct cause of the pain. Most primary pain is chronic pain.
Other terms for primary pain include neuroplastic pain, centralized pain, persistent pain, and central sensitization.
Key Insight:
We can have pain that is purely primary, but we never have pain that is purely secondary. Why? Because all pain is ultimately created by the brain.
Why Pain Is Never Purely Secondary
Here are two examples that demonstrate how pain is always influenced by the brain:
Pain decreases even when tissue damage persists:
If pain were purely secondary (i.e., directly proportional to the amount of tissue damage), it would last as long as the damage is present. However, we know that after bandaging a cut or casting a broken bone, pain often decreases significantly. At some point, even with some tissue damage remaining, the pain can disappear entirely. This happens because the brain no longer interprets the injury as a threat, regardless of the physical damage that is present.
Different people, same injury, different pain levels:
Two people can experience the exact same injury but report vastly different pain levels. If pain were purely secondary, both individuals would feel the same amount of pain. However, because pain is created by the brain, and every brain is shaped by unique life experiences, their responses to the same injury vary.
These examples show that pain (even secondary or acute pain) is never a direct reflection of tissue damage. It is always influenced by the brain. Therefore, all secondary pain has a component of primary pain.
Why the Distinction Matters
At first glance, primary and secondary pain might not seem much different from chronic and acute pain. So why make the distinction?
The difference becomes critical when:
We have pain that seems acute but is mostly primary
We have pain that seems chronic but is actually secondary
If we automatically assume all acute pain is secondary or all chronic pain is primary, we risk pursuing ineffective treatment options.
Identifying and Treating Your Pain
If you’re wondering whether your pain is mostly primary or mostly secondary, you can take this quiz to get started. The higher your score, the more likely it is that your pain is primary and may respond best to a mindbody approach, such as Pain Reprocessing Therapy.
Treatment Options:
For mostly secondary pain:
Give your body time to heal while gradually resuming regular activities.
Work with a skilled provider, like a licensed physical therapist, for specialized support to ensure efficient recovery.
For primary pain or mixed pain:
Collaborate with a provider trained in mindbody modalities, such as Pain Reprocessing Therapy, to address elements of primary pain that may be contributing to increased pain intensity, frequency, and/or duration.
What’s Next?
In upcoming blog posts, we’ll explore:
How secondary pain can transition into primary pain
Why it’s possible to have physical “damage” without pain
Understanding the distinctions between primary and secondary pain can empower you to make informed decisions about your treatment. Remember, pain is always real, but its causes and solutions can vary widely. The more we understand about pain, the better we can treat it.
