What is the difference between acute pain & persistent pain?

Acute pain tends to be related to a specific injury, where soft tissues are injured, such as an ankle sprain. This type of pain tends to settle down over a 6-12 week time frame, but in some cases may take up to 6 months. This pain is designed to be an alarm system, telling us that we need to rest the affected area in order for healing to occur. The amount of pain we experience can vary from one person to another, based on the severity of the injury, our past experiences and even how worried we might be about the symptoms. This type of pain serves a useful function.

Persistent pain lasts beyond usual healing times. It used to be thought that this is due to ongoing damage, but scientific research has shown that this is unlikely. The pain is more likely to be related to the nervous system (brain and nerves) becoming sensitised, a bit like the volume on your radio being stuck on loud, which means you may experience pain without tissue injury. This type of pain does not serve a useful purpose. When this happens, it can be difficult to do your normal activities. It is possible to turn the volume down, but it takes time and effort. This means that quick fixes, such as medications, injections and operations are often unhelpful. To find out more about persistent pain, click here.

Medically unexplained pain symptoms are relatively common and the diagnosis is often reached when other causes for the pain have been excluded. This can be a frustrating and confusing journey, but you are far from alone. It is estimated that 45% of GP consultations and up to 50% of new hospital appointments are used for this exact reason! (Reference here)

Fibromyalgia is a persistent pain problem that can cause widespread pain in the body. It is estimated that 1 in 25 people may be affected. In addition to widespread pain, people with fibromyalgia often describe increased sensitivity to pain, tiredness and fatigue, muscle stiffness, difficulty sleeping, headaches, irritable bowel syndrome (IBS) and memory/concentration problems (often known as fibro-fog). The pain in fibromyalgia is often triggered by a physical or emotionally stressful event, although some people cannot recall any event in the lead up to symptoms starting.

The exact cause of fibromyalgia is not known yet, there is no specific test that can diagnose fibromyalgia, but recent research suggests there is a link between our physical and psychological wellbeing. Anxiety and depression can be part of this overall experience and the end result is similar to that experienced in persistent pain problems, where the nervous system (brain and nerves) becoming sensitised, a bit like the volume on your radio being stuck on loud we mentioned in the previous section. When this happens, it can be difficult to do your normal activities. It is possible to turn the volume down, but it takes time and effort. This means that quick fixes, such as medications, injections and operations are unhelpful.

The reason these interventions can be less helpful is that the nervous system takes short cuts to improve efficiency. This is affected by past experiences, thoughts, expectations and emotions, not only tissue damage/injury. A good example of this is someone with widespread joint pain, where movement causes pain. To improve efficiency, your nervous system predicts that moving your joints/muscles will hurt, even if you are not receiving pain messages from the structures in the joints/muscles. This is not a conscious decision and is completely normal, although it may be unhelpful in many circumstances.

This explains why many treatments, such as injections have limited benefit. Injections and operations work on the local structures, but the nervous system is predicting movement will hurt, so you still experience pain symptoms. To improve this, we have to work on ways to challenge that prediction, which may be by starting with novel and gentle movements, or with exercise such as Tai Chi, to either trick the nervous system, or train it to better tolerate movement.

The pain symptoms often lead to people becoming less active, but this means that the muscles get weaker and sleep quality gets worse. The symptoms and reducing activity is often referred to as a vicious cycle. Pain can also impact on your relationships, as you may feel less patient, experience negative thoughts, feel your mood is affected or less able to do the things you used to do. It can be difficult to adapt, but there are positive steps you can take to improve your situation, including being referred to the Circle MSK service.

The best way to treat your symptoms depends on the type of pain you are experiencing.

If you are experiencing acute pain, medications from your GP or over the counter medication may provide relief of symptoms whilst you get back to normal. Gentle exercise and movement can be helpful, please see the body site specific sections on our website to find out more. If you continue to experience symptoms, then the MSK service has a range of options to help get you back to the activities you love. These include:

Physioline – a physiotherapy assessment and advice service, offering a short wait time to expert advice.

Physiotherapy – face to face physiotherapy for assessment and treatment of your problem area.

MSK clinic – for further assessment and perhaps imaging, if this would be useful to your care.

Hospital referral – for assessment to treatment, including surgery if this is appropriate.

The treatments offered for each body area can offer a great deal, so please see the relevant page, e.g. Knee Pain etc. pages on our website under the “conditions” tab

If you are experiencing persistent pain, our team of therapists can support you via a range of services designed to meet your needs, such as our multi-disciplinary pain team, LEAP pain management programme, Clinical Psychology, Back Skills Training or Physiotherapy. Any improvement requires commitment, both in terms of being open new ideas and the time investment in attending sessions. Click here to find out more.