Acute Pain Management
Defined as the physiologic response and experience to noxious stimuli that can become pathologic, acute pain is normally sudden in onset, time limited, and motivates behaviors to avoid actual or potential tissue injuries.
Acute and Chronic Pain
Acute pain, unlike chronic pain, is self-limited discomfort that typically lasts from a few moments to several weeks but less than three to six months.
It can relate to soft tissue or skeletal damage, and may be categorized as spontaneous or post-traumatic, with the trauma. As the injured tissues heal, acute pain gradually resolves. In the meantime, the pain can vary in severity from mild to severe.
This type of pain is caused by a specific event, such as a broken bone, burns or cuts, or even labor and childbirth. The pain goes away once the affected area has been treated by time, topical aids, or pain medicine. Some acute pain is temporary and short-lived. Other times, it can have a longer-lasting effect and cause severe pain.
Therapy for acute pain treats the cause of the pain. However, it can be difficult to diagnose as the symptoms can be start and stop without warning. It can be difficult to treat acute pain with pain medicine as the pain does not last all day and night, and can produce symptoms that last a few days, a few seconds, or even just a few seconds.
Types of Acute Pain
Mildly painful spontaneous conditions include headache, upper respiratory infection, or back and neck pain from activities such as doing yard work, and may be self-treated with rest-ice-compression-elevation (RICE) therapy and over-the-counter analgesics.
Moderately painful conditions include a sprained ankle, strained ligament, deep laceration, or simple bone fracture.
These may require interventions such as minor outpatient surgery or splinting, but are generally managed with non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen. Severely painful conditions include trauma such as a motor vehicle accident, traumatic amputation, or burn, and will likely involve surgery and a protracted hospital stay.
A stronger combination of analgesics, including opioids, may be required. Of course, the pain level for each case must be individually determined.
Elective or Planned Procedures
Pain management for office procedures, including immunizations, phlebotomy, or catheter placement, tend to result in mild acute pain that is usually eased topically or without intervention.
Pain management for moderately painful procedures that may result in acute postoperative pain, including same-day dental, arthroscopic, laparoscopic, or podiatric surgeries, may be managed with simple pain medicine, such as NSAIDs and acetaminophen.
At most, a total of 6 to 8 doses of an opioid and acetaminophen combination might be needed for adequate pain relief if the patient’s discomfort is not controlled with simple analgesics, but this approach comes with many risk factors discussed below.
Severely painful procedures include surgeries requiring inpatient stays, such as orthopedic joint replacement, spine surgery, or colorectal surgery.
Chronic pain is an ongoing pain that last longer than six months. This pain is considered a disease state and affects one in five American adults. Chronic pain is hard to diagnose and can be misdiagnosed.
Chronic pain is caused by an underlying issue, something surgery may not be able to heal. Pain patients may undergo a variety of treatments to find one, or a combination of many, that helps reduce their pain.
Many types of chronic pain are headaches, arthritis, cancer, nerve pain, back pain, and fibromyalgia. Pain is different for everyone, especially chronic pain. Because of this, treatment options for chronic pain vary and can include everything from a topical cream to surgery.
Neuropathic pain is caused by damage or injury to the nerves that transfer information between the brain and spinal cord from the skin, muscles and other parts of the body. The pain is usually described as a burning sensation, and affected areas are often sensitive to the touch.
Common causes of neuropathic pain include nerve pressure or nerve damage after surgery or trauma, viral infections, cancer and cancer pain, vascular malformations, alcoholism, neurological conditions such as multiple sclerosis and metabolic conditions such as diabetes.
It may also be a side effect of certain cancer pain medications. Occasionally no identifiable cause is found, which can be understandably distressing for the individual experiencing the pain.
Chronic neuropathic pain is common and may be related to an underlying health condition such as cancer or diabetic neuropathy, or it could be related to treatments for cancer pain such as chemotherapy.
Transcutaneous Electrical Nerve Stimulation
Transcutaneous electrical nerve stimulation (TENS) therapy involves the use of low-voltage electric currents to treat both acute pain and chronic pain. A small device delivers the current at or near nerves to block or changes the patient’s perception of pain.
This pain management device could allow some access to a pain medicine-free way to treat acute pain.
What is the best medication for Acute Pain?
Over the counter and Prescription Pain Relief
Acetaminophen is the first-line treatment for most mild to moderate acute pain.
Ibuprofen and naproxen (Naprosyn) are good, first-line NSAIDs for mild to moderate acute pain based on effectiveness, adverse effect profile, cost, and over-the-counter availability.
Cyclooxygenase-2 selective NSAIDs are second-line medications for mild to moderate pain, based on their similar effectiveness to nonselective NSAIDs and greater costs.
Celecoxib (Celebrex) alone and an NSAID plus a proton pump inhibitor have the same probability of causing gastrointestinal complications in those at high risk.
Opioids, traditionally considered the most potent analgesics, are frequently used for acute pain and come with many risk factors. Severe acute pain management must be considered within the context of the current opioid crisis. Opioids are typically reserved for more severe pain.
However, even if pain is severe, prescribing opioids should not be taken lightly, and it is important to consider other forms of pain management and recognize that treating acute pain does not always require opioid therapy.
Over the past 10 to 15 years, there has been over-utilization and chronic opioid use for acute pain. For these reasons and many more, non-steroidal anti-inflammatory drugs may be a better first treatment.
The increased opioid prescribing and availability has led to increased abuse and misuse. Studies suggest that patients discharged on opioids are more likely to remain on opioids 1 year later compared with patients who were not discharged on opioids. Opioid prescribing quadrupled from 1999 to 2010; concurrently, the number of opioid analgesics deaths and opioid use disorder cases similarly rose sharply.
Manage Pain and improve Quality of Life
Quality of Life Medical and Research Center is a multi-specialty medical center providing primary and specialty care for our patients, and conducting clinical trials for a variety of sponsors and contract research organizations to treat acute and chronic pain. Located in Tucson, Arizona, we have a rich history of serving the people of Southern Arizona.
Whether you have a current complaint or would like to make wellness a priority, come feel the Quality of Life Difference.
You may want to find out about “What You Need to Know Before Your First Pain Management Appointment“
Additionally, please read more about “Effective Treatments for Opioid Addiction“