Chronic vs Acute Pain

In chronic pain, there is a crucial and fascinating secret to how your pain system works. Understanding chronic vs acute pain has been a key to recovery for many people.

The classical distinction between chronic and acute pain is simple: it’s the length of time you’ve been in pain.

If you’ve been in pain longer than three months, this is chronic pain. Less than 3 months: acute pain.

This definition has nothing to do with how severe the pain is. You can have very mild pain for 2 months, and that’s deemed to be acute pain. You can have extremely severe pain for 2 years, and that’s chronic pain.

The most important thing to recognize, though, is that these are fundamentally two very different conditions. Many problems occur when people to treat chronic pain in the same way they treat acute pain.

Understanding the difference between these two conditions gives you a much better chance of recovering from chronic pain.

The Difference Between Acute and Chronic Pain

A group of people can have the same underlying problem on xray or MRI – for example, damage to the disc in their spine. However, the fascinating thing is that everyone presents with their own unique blend of symptoms.

So one person will wake up free of pain and the pain increases over the day – they just hang out to lie down to relieve it. The next person will be pain-free during the day and will be woken at 2 am with excruciating pain. A third will have pain whilst sitting and the 4th whilst bending, and so on. The patterns of pain are all different and all unique to each individual.

So if the underlying disc injury looks the same, surely the factors setting off, worsening and relieving the pain should also be the same?

That is a perfectly logical question and would be true if the only factor causing the pain was the damage you can see in the disc.

If this isn’t the case (as is true with many people in chronic pain) there must be something else causing pain. It must be a factor that’s separate from the disc, the joint, the muscle, the ligament, or any structure you can scan in the body. What can it be?

Let’s answer question.

If someone was to kick you in the shin, where would you actually feel the pain?

Almost everyone would answer: “In my shin.”

However – what would happen if you were in a deep sleep or unconscious?

You would feel nothing. Why?

Because the place you feel all pain is in your conscious brain. In fact, the place that you feel anything is in your brain. Maybe you only exist because of your thoughts and they create & set the boundaries for your reality.

So, as in Alice in Wonderland when the white rabbit disappears down a tunnel- things get more and more interesting…

The truth is that you can feel excruciating pain in an area when there is no damage or even if that part no longer exits. This is well recognized in sthe phenomenon of phantom limb pain.

Here someone has a chronic painful limb (often with diabetes or poor circulation where it becomes infected.). Eventually, a decision is made to amputate the limb. So, on waking up, the surgeon asks the patient: “How does it feel now that your sore leg has gone?”

And the patient answers: “I can still feel the terrible pain between my 1st & 2nd toes!!!” 

But their foot is gone, so where are they feeling the pain in their toes?

Now we can answer confidently: every one of us feels pain in our brains.

How Pain Works

There is a neuromatrix which contains a picture or image of our whole body and where the real business occurs. This is where we localize sensations and make sense of them. The stuff coming from our body is actually information which needs to be interpreted by our brain before we feel anything.

This is how two disc injuries can look similar on MRI, but the people with the injury have a unique pattern and pain signature.

This is the key to understanding, managing and curing chronic pain. The secret to acute vs chronic pain is that with acute pain, the problem is physiological. With chronic pain, there can be physical factors. But the major factor that’s invisible is the pain system itself.

With chronic pain, the pain system is malfunctioning, causing the person in pain to feel more pain than they should be. This is how someone can feel pain long after an injury has healed.

This is how someone can feel a great deal of back pain, when there’s normal wear and tear showing on an MRI. This is how an illness like Lyme’s disease can set off widespread chronic pain. And even after the disease has run its course and burned out, the person continues to spend each day in pain.

Take the Chronic Pain Quiz…

To find out more about chronic pain vs acute pain, and to find out whether your pain system is a factor in how much pain you’re feeling, click the button below to take the chronic pain quiz:

Take the Chronic Pain Quiz

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(13) comments

Anna July 16, 2009

This is really fascinating!
I always felt that it is all in our brains anyway:).

So, does it mean that working with a particular part of brain we can alleviate chronic pain? (by the way, how is that possible?)
And would it work for other kinds of pain?
Does it mean that pain means that something has to be fixed …in our mind? (like in metaphysics they say there is a particular connection btw your emotions and pain/sick body part?)

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tony July 17, 2009

I would love to believe this. I also read that a doctor once stated that any pain felt after 6 weeks does not exsist. That is rubbish I did some damage to my back and the pain was excrutiating, and no way could a few distracting thoughts mask it, even after 6 weeks. The people who believe this obviously have never suffered enough.
Apart from this part the site is very informative

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Jonathan July 20, 2009

Hi Anna

You have asked a number of insightful questions.

Yes you can alleviate [& sometimes cure] chronic pain by working with a part of your brain. This is a well recognized & researched mode of treatment called Cognitive Therapy.

Dr John Sarno MD runs a Pain Clinic in New York & has successfully treated thousands of people in chronic pain by teaching them how to use the power of their mind to treat their chronic pain. He has a particular theory about this problem, which is fascinating.

There are many other successful therapists using other techniques & theories.

It works, to an extent, with pain of any any kind.

Instinctively we know that Pain means something is wrong and needs to be fixed. This is a vital safety mechanism with evolutionary survival significance to all creatures. We also know instinctively that if a certain part hurts- that is the bit that needs fixing.

However in chronic [long lasting] pain – the pain may continue long after the damage has been healed in the body. This is the huge challenge in coping with and in the treatment of such pain. Under these circumstances, continuing to treat the previously damaged area [back, neck etc] will not give long lasting pain relief. Recognition must be then be given to the mind/body interaction if real progress is to be made.

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Jonathan July 20, 2009

Hi Tony

I agree with you that the doctor who wrote that “any pain felt after 6 weeks does not exist” – is talking rubbish.

There are many painful conditions in the body where the process of healing takes much longer than six weeks – for example a fractured femur takes at least three months to properly heal and so almost everyone will feel pain in their leg for considerably longer than 6 weeks. However once healing has been completed in the fracture and with proper rehabilitation, pain should go and proper function should return. This will happen in the vast proportion of people.

This is also true of some sore backs. If you tear a disc annulus or especially if you have inflammation within the disc itself [as in Internal Disc Disruption] -then you may have significant & at times, excruciating pain in your back arising from this underlying damage. This may take up to 2-3 years to heal.

However many more people have pain for many years in their back after a relatively minor incident. Investigations including CT & MRI scans show some wear & tear which are just age related changes. For these people the PAIN IS REAL and can be excruciating. However there is no observable damage in the back which could explain the extent of the pain and the length of time they have suffered from it.

Here – it is being increasingly accepted by authorities that the primary factor driving this pain lies within the Central Nervous System -ie the brain.

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Lesley Stoddart January 23, 2010

Diagnosed with Fibromyalgia 10 years ago 99% of my pain now is in trigger points in my right butt.Many times I have tried releasing these by finger pressure or tennis ball. Every time it makes matters much worse.The difficult thing is that the pain screams at me to press into it as in the first instance it gives some [ very short lived ]release .I am a fan of John Sarno’s work but have never manged to get relief from trying to do what he suggests ie journaling & thinking psychological as when I try to do this the physical pain is so awful I have to press the trigger points & hey ho here we go again, I have made the pain much worse. Any suggestions please for a desperate wee Scots lass who used to be very active & who would love a painfree life again ?

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    Jonathan February 12, 2010

    Hi Lesley

    Chronic pain in the butt is unfortunately a very common problem. The pelvis is the centre of the axial skeleton
    and there are significant stresses in the bones, joints and soft tissues [muscles, tendons, ligaments] during all activities, especially with postures like standing, squatting, walking etc. This often means that pain which is felt/ perceived in the buttock is multifactorial- coming from various structures in the pelvis.

    There are also structures both above and below the pelvis that refer pain into the buttock. Finally you also have been diagnosed with Fibromyalgia, which means that your pain system will tend to amplify messages from your body- changing normal sensations into pain & intensifying any pain messages. This adds a further layer of complexity.

    Common structures in the pelvis which can set off pain [medical jargon- the nociceptive focus] include:

    1] The Sacro-iliac joint [SIJ]. This is particularly vulnerable and SIJ dysfunction or injury is a potent cause of ongoing buttock pain. Often the surrounding muscles will move into ‘protective’ mode- ie into spasm and turn on trigger points. Treating the TrPs in this situation will only give temporary relief at best. You need someone to assess the SIJ and treat. Treatment can be manual initially which is often very successful. If that does not help, then a cortisone injection into the joint [under image intensifier control] or prolotherapy [injection of concentrated glucose into the ligaments surrounding the joint]- can be effective. Then treating the trigger points will give long lasting benefit.

    2] The lower lumbar spine. – often pain from L4/5 &/or L5/S1 segments will be perceived in the buttock. This can come from injury to the disc, the facet joints or the muscles controlling those segments. Again you need someone competent to assess your lower back. Imaging- especially MRI can show disc damage [which is probably the commonest cause of ongoing chronic pain in this area.] There are many different approaches to treating lower back pain. [huge & confusing subject]- but if you have effective treatment- then the buttock pain will go.

    3] Occasionally intra-pelvic organs – like bowel or aorta/blood vessels can refer pain into the buttock.

    4] Trigger points in hamstrings, leg adductors and occasionally the calf muscles can refer pain up into the buttock.

    Usually the situation involves more than one structure in more than one place. So L5/S1 disc plus some SIJ dysfunction with associated TrPs in erector spinae muscles, quadratus lumborum and gluteal muscles….. All need to be treated. Also your Fibromyalgia needs to be assessed & treated.

    So Lesley- you need to find a competent practitioner or practitioners with a wide view on the workings of the area and who have a variety of skills. Often they and you need to ‘chip away’ at the problem until it goes or becomes managable.

    Kind Regards
    Jonathan

    [Please note- I cannot suggest a specific treatment for your complaint as I have not taken a full history, examined you or reviewed your investigations.
    Therefore all comments I make can only be general – relating broadly to the problem you have described. ]

    Reply
Dorotka Wisniewski January 29, 2010

This is such an interesting topic. It is probable that Lesley’s “butt” pain is a satelite trigger point and not a key trigger point. You may want to check quadratus lumborum ( a key trigger point) which refers into areas of the butt.

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    Jonathan February 12, 2010

    Hello Dorothy

    You are absolutely correct.

    The buttock pain is not going because Lesley is treating a secondary problem- the obvious TrPs in the buttock.
    Quadratus Lumborum [QL] is often a significant cause of buttock pain. This is missed because it is found outside the perceived pain zone and is situated deep
    and quite far away from the lumbar spine. Accurate pressure over the QL TrP can cause the most excruciating deep ache. Treatment of this TrP is one of the most satisfying and usually gives good results.

    Regards
    Jonathan

    Reply
Tanja March 10, 2010

Hi Jonathan,

Thankyou so much for your information,

I have a partner who hasn’t yet aligned his mind body connection and needs some major relief and understanding of why his pain is occurring daily and how to live with it and beyond and I have also suffered whiplash and finding ways to assist myself too.

My partner had worn down the cartilage in his right knee, being a knockabout tradie, electrician he soldiers on over the years.

He does go up and down ladders and finds it painful to kneel, finally visits a doctor as pain was a bit much.

A couple of years ago he visited a surgeon who cleaned the knee out and also cleared some cysts and pricked the top of the bone to try and get the marrow to grow etc.

Pain still persisted and in desperation my partner asked if he could be on the 5 year clinical trial for a new shock absorber for the knee.

They place a brace on the lower leg and a brace on the top leg and put screws into the bone and i think he has at least 8 screws or more.

There is a spring that runs through a sleeve from the upper leg and attached to the lower brace and this is how the shock absorber works, providing a gap between the bones and seems to be successful with most of the patients, not as successful for my partner at this stage of the trial.

The doctor has commented on the fact that his muscles are really tight, he has thick muscle and the muscle that was cut or stretched seems to lack strength and has a big scar on the medial lower thigh.

He dosen’t have the same pain previous to operation but he has another form of pain occurring in the front part of knee attached to lower leg and sometimes inner thigh and outer etc, tension in tendons and a lot of fluid build up in the joint and the doctor has diagnosed him with osteo athritis and fatty tissue or fluid buildup behind knee as well etc.

The doctor says my partner’s leg looks the worst on the trial and has advised him to give up his work at the end of the year and this is causing stress as this is what he has to do at this time to create income and he may need a total knee operation in years to come, he didn’t advise this as a first option as he felt he was to young, seems to be letting him know now, there is no referral for daily pain management and relief at this time and that is what we need at this time.

My partner is holding on to the doctors words and I feel he needs to work on himself now and find the real cause of pain if it is the knee or muscles etc, maybe the trigger points and feels like we have to try trigger point therapy anyway.

I do believe in holistic approach, mind body connection,meditation, osteopathy, acupuncture, bowen and also nueromuscular techniques and trigger point therapy, anything that assists wellbeing.

His surgeon says the clinical trial/knee brace/ shockie is doing okay, the knee itself seems to be gaining more fluid especially when kneeling or bending etc, basically using it.

The surgeon says medical science can’t do anymore its up to partner now and I understand that it is time for him to move into his own self management.

He dosen’t seem to know how or what to do, I am not experiencing his pain but i feel for him when in pain and I have pain from my own accidents years ago.

I have learned to work with it, most days move beyond and some days get caught up in it.

I am here to assist us both as we seem to have to live and work through chronic pain at this time in our lives.

I would like to know what is real pain and what is built up over time, maybe the trigger point therapy will provide relief and be a new step and a way for self healing from chronic pain etc.

I was wondering if having a big scar on the inside upper leg muscle,would cause trigger points and the ITB’s are also very tight, and shins and areas around tendons of the upper leg close to the knee joint, any response is appreciated, Thankyou, all the best. Tanja.

P.S. Does releasing the trigger points have an affect on releasing fluid in the tissues or around knee joint?

Any response will be greatly appreciated thankyou for your website and sharing your experiences,knowledge,wisdom, and expertise, all the best, Thankyou Tanja.

Reply
    Jonathan March 13, 2010

    Hello Tanja

    It sounds as if your partner has had quite innovative surgical treatment. The trial sound very interesting- but remember it is a trial and outcomes will be constantly evaluated. If not adequate, the types of treatment will either be modified or discarded.

    There is no doubt that the large scar on his leg can set off TrPs. There are many TrPs in the thigh which refer pain to the knee. So your partner actually feel the pain as though it is inside, in the the front, side or back of his knee joint. These occur in the quadriceps femoris [the quads], the adductors [on the inside] or the hamstrings & some calf muscles [in the back of the knee. These can make the knee feel stiff and sore.

    They may be primary [most important cause] or secondary [to the underlying osteoarthritis]. If you treat them using the principles I have shown of ischaemic pressure and stretching – he may find surprising and significant relief of his leg pain and increase in range of movement.

    Proper functioning muscles actually reduce the impact on the joint. So treating these muscles may reduce the swelling in the joint. This swelling is usually a response of the body to the damage within the joint itself.

    In a few weeks I am bringing out a video on the way to diagnose & treat this group of muscles.

    Regards
    Jonathan

    Reply
Richmond April 16, 2010

Hi Dr K,

I would be interested to hear where you see emotions fitting in to this approach to pain.

From my end, emotions is where/how the mind and the body meet
(and yes, i think you are right when you state the mind is not the same thing as the body)

I would be interested in your thoughts on the idea that often the body will hold/store/carry the emotions of an event/trauma and that therefor pain will continue until the ’emotion’ of the event has been released,,, and that often that doesn’t occur at the time because there is some learning for the mind/ conscious mind at least to assist the person into a higher level of reorganisation?

thanks
Richmond

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    Jonathan April 29, 2010

    Hi Richmond

    YES!!

    I agree completely. I no longer see [the body] & [the mind] as separate in any way. There is bodymind which totally integrated. In fact now there is a rapidly growing body of knowledge which shows that the gut produces 80% of the serotonin [feel-good neurotransmitter] of the body and has a ‘brain ‘ with millions of nerves and ganglia within the submucosa. Your heart has a network of ganglia which acts as a mini-brain ..and so on. So emotions are very powerful forces for health or illness.

    I like and agree with your concept of your body carrying the emotions related to a traumatic event and it may require the person to ‘move through’ or come to terms/forgive/resolve the emotions before healing and pain relief can occur.

    Kind Regards
    Jonathan

    [Please note- I cannot suggest a specific treatment for your complaint as I have not taken a full history, examined you or reviewed your investigations.
    Therefore all comments I make can only be general – relating broadly to the problem you have described. ]

    Reply
Colleen Haraldsson January 27, 2013

Hello Jonathan,
Could you give me your opinion on Epidural steriod shot for herniated disc L4 L5 . My husband has been in severe pain for a month now and can barely walk and sitting is extremley painfull. All prescribed pain narcotic medicines have not giving much relief at all and he gets maybe a 2 -3 hours sleep in intervles he recently had a Epidural a week ago which didn’t really give any pain relief but he can hobble around on his feet for a short time which he couldn’t before the shot. My question is would a second and possibly third steriod(series) shot going to benefit him? and i have been told if the first shot does not give any significant improvement then we should explore surgery as his pain is preventing him from daily activities let alone work. Than You For you Time..Regards Colleen Haraldsson

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