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01/18/2008 02:25 PM

What Is Acute, Chronc And Intractable Pain?


What is Acute, Chronic and Intractable Pain?

Doctors separate pain into 3 categories: acute, chronic or intractable. When an injury or illness is in the acute phase, it has a biological basis and warns a person to seek medical help. It can also be used as a diagnostic tool in pinpointing the proper sources of pain.

Dennis (1978) suggests that acute pain is normally associated with a well defined cause (such as a burned finger or ruptured appendix), typically has a characteristic time course and goes away after the person has healed. This type of pain may be slight and last a minute such as a wasp sting, or it may be severe and last for weeks or months such as a burn.

Chronic pain is a pain state where there is persistent pain lasting a minimum of

6 months and usually the cause of the pain cannot be removed, found or otherwise treated.

Black (1973) suggests that the most important distinction between acute and chronic pain is

that the pain is no longer serving as a warning signal but has become and end unto itself and that the patient suffering from chronic pains lifestyle has been significantly altered due to the disorder. Chronic pain lingers beyond the “normal” time of healing,. It not only causes physical pain and tissue damage, but also places severe emotional, functional, social and

spiritual stresses on the individual who is suffering. Although the pain may have started as acute pain, other types of pain often develop slowly, making this type of pain difficult to treat. Chronic pain can also result from diseases such as shingles or diabetes, from trauma,

surgery or without a specific known injury or disease.

Chronic pain ranges in severity from mild to disabling and can be felt daily 7 days a week for 24 hours daily or can be experienced intermittently with times when the pain is not perceived. This type of pain is no longer valuable and used as a warning to indicate

harm or potential danger to the body. Usually the whole person suffers. Intractable pain is a more severe form of chronic pain. It is extremely different from acute pain but differs slightly from chronic pain. The definition of chronic pain does not take into account treatments already attempted, those that have

helped or failed or even the prognosis for the person suffering.

Intractable pain is pain which is extremely severe in nature, unremitting, incurable and of such severity that it dominates virtually every conscious moment, produces psychological and physical debilitation

and may produce such depression in the individual that they may wish to end their lives for the purpose of extinguishing the pain. Intractable pain is considered to be extremely severe, unremitting, and to date no cure can be found to relieve the pain problem.

The mechanics that cause chronic or intractable pain are very complex. There usually is tissue damage or a disease process, which causes chemicals such as serotonin, histamine, bradykin and prostaglandin to be released in the human body. These chemicals cause the nerves to become more sensitive to pain. As time progresses a chemical called substance P is

released from the peripheral nerve endings. This substance carries pain signals. The more substance P that the nerves release, the more sensitive the person becomes to pain.

There are numerous medical conditions, which commonly cause chronic or intractable pain.

Some of these conditions are: arachnoiditis, back injuries, failed back surgeries, migraine

headaches, fibromyalgia, adhesions and scarring from previous surgeries, rheumatoid arthritis,

osteoarthritis, cancer, systemic lupus erythematosus, reflex sympathetic dystrophy, myofascial

pain, spinal stenosis, referred pain, neuropathic pain, endometriosis, interstitial cystitis,

irritable bowel syndrome, neck pain, carpal tunnel syndrome, etc.


09/26/2010 01:50 PM
Posts: 281

THANK YOU very much for sharing...this is exactly what i was feeling, but had challenging time putting into words. I have suffered acute, chronic and now intractable. I have syringomyelia, a rare spinal cord disorder which i have read is also called 'the cancerless death' suffers as a cancer patient, but the cell make up is different. thank you againf or sharing! where is your new page you set up?? i would love to join that one & let us all work together to get the help we need re: medications, education, etc...Blessings Smile

09/26/2010 07:35 PM

What I know is acute pain would be from an injury or a pain that just started.


Chronic pain is from illnesses where there are no cures. They become life long.Medications usually daily and don't help much.

I hope that helps. --Nickie

09/28/2010 02:35 PM
Posts: 69

Life long pain is pain where nothing can be done to solve the problem. they give you narcotics but it something we live with. many have many reasons, some one. but it hurts and does not give up susan

09/28/2010 06:11 PM
Posts: 2771
Senior Member

Thanks for sharing the description with us. It was very interesting. I knew the difference between acute and chronic, but never thought about intractable.

Who would determine if your pain is considered as chronic or intractable...the dr. or the patient?

10/03/2010 04:19 PM

Sure hon! One or more of your doc's would have to write it in your file.

10/04/2010 12:07 AM
Posts: 113
I'm an Advocate

My bone disease causes acute, chronic AND intractable pain. Imagine a person whose bones in their fingers, upper and lower arms, shoulders, collar bone and ribs PLUS all of the joints in between all of these bones having tumors either snaked around or inside pushing out of them. Then imagine that these tumors are constantly growing very slowly and putting pressure on the bones and joints either from the inside like a hard, expanding balloon, or from the outside like a vice and that the bones are constantly experiencing micro-stress fractures. At some point, these micro fractures open up or the bone actually breaks. This is what Ollier's disease can do. For some people with this disease, there are surgeries which can remove these tumors and even replace some of the bone which can be lost by the crushing. It's usually a childhood disease and the tumors usually only grow during the child's growth cycles. When I was a child, I did have reconstructive surgery to remove some of the tumors and to reconstruct most of my fingers as well as some bones in my hands. The disease was dormant for 10 years and, without warning, became active again. It's never been known to be active in an adult unless it's turned malignant. In my case, it's not malignant but it is active and progressive. I've been living with it as an adult for 17 yrs and it's been well controlled with pain medication. However, due to the nature of the disease, I have to take several differnt opiates in order to control the different types and degrees of pain. My doctors, some of them, have been very good at controlling the pain enough so I can learn to live with a certain amount while still having my full mental faculties which is very important to me. For those of you who are new to the world of chronic or any kind of constant pain which interferes with your life, do yourself a favor and become your own expert and your own advocate when it comes to medications and pain management. Talk to pharmacutical companies, pharmacists, research medications and other pain management tools, surgeries, procedures on the internet. Call or email these researchers, find out about any new trials, even if you may not qualify for them.

You'll be surprised how many healthcare professionals don't know the difference between these types of pain and that they require different medications/techniques in order to control them. If you haven't educated yourself so that you can advocate for yourself, you could find yourself being labeled as a "drug seeker" by some ignorant healthcare provider in an ER or even in-home physical therapy. It's happened to me and I've had to fight to get the label removed. If I hadn't educated myself and made sure that my doctors don't medicate me into a mindless haze, I would have found myself denied the medication and treatments I need in order to live my life by those ignorant of these different types of pain and the need of different medications to treat them.

One nurse labeled me a "drug seeker" because I was out of my immediate release morphine which is needed for "breakthrough" pain for when the tumors cause "acute" pain and my extended release morphine is not capable of bringing the pain back down to a manageable level. I was in need of in-home care at that time and when I told her that I was out of my IR morphine she told me that I would be fine because I still had morphine ( even though it was extended release). I tried to tell her that the ER morphine was not enough at that point and she told her supervisor that they could discontinue my in-home care because I wasn't in need, I was a "drug seeker". They did discontinue my care! I had to file a claim against the nurse and the company with the state and my health insurance and was lucky enough to have a doctor and several specialists who truely understood my case and disease and stood behind me. If not for my ability to put my claim in writing to the state health board and do so in a manner in which they could understand my condition, differences in the pain I suffer and the reasons behind the different medications I take, I wouldn't have been able to get another in-home nurse aide and physical therapist and the label of "drug seeker" would have folllowed me everywhere I tried to get medical attention. Because I did educate myself and I did fight, I got the in-home care I needed. I no longer need in home care and am on my way back to being able to do some of the things I did before the incident which lead to my being homebound. This wasn't the first time a healthcare professional attempted to put that label on me and probably won't be the last. I still suffer from the disease but I continue to search for new ways to manage my pain and I push my doctors and specialists to do the same. Although I've lived with this for 17 yrs as an adult, up until the past 5, my doctors helped me to remain active, ride my horses, run an animal rescue and be there for my husband and son when they needed me. It's been a long 5 years but, with help from my physical therapist, I hope to be back to riding my horse next spring. Everyone here is suffering some awful disease or injury which has left us with pain for the rest of our lives. We need each other because most people, even doctors and nurses, can't understand what that means. To everyone out there, I hope today is one of your "good" days and that you have more good than bad. Macv

10/04/2010 04:00 PM

Your post is very interesting!

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