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Understanding and managing acute pain


blog rahman pain

Acute pain, unlike chronic pain, resolves itself in time and is not persistent. Acute pain has a short duration, though it can vary from seconds to hours or days to a few months (usually less than six months). 

Someone with acute pain has a reasonable expectation that the injury will heal. Chronic pain, on the other hand, persists over a long period of time.

Acute pain has an identifiable etiology, or cause, such as surgery, trauma or an injury. The source of the acute pain can be tissue injury or inflammation. Patients may feel anxious with acute pain, causing their heart rate, blood pressure and respiratory rate to increase. These changes indicate the activation of one's sympathetic nervous system. Physical signs and symptoms of acute pain include light-headedness, dizziness, nausea, sweating and debility of function.

Pain can appear to be simple to manage, but in the clinical environment, acute pain can have many complex layers that need to be understood. Pain is difficult to measure because it is based upon the subjective experience of the patient dealing with the pain. An acute pain assessment is based upon the patient's previous experiences with pain and current expectations of an acute pain episode. There are no available objective diagnostic tests that can indicate the level and intensity or even the existence of pain.

Measuring pain is not as simple as checking a patient's blood pressure or measuring a blood serum level. Pain assessments use a numerical rating scale between zero to 10. Zero indicates no pain, while 10 indicates severe pain. Physicians analyze a patient's pain score along with the patient's ability to function (get out of bed, walk around the unit, perform activities of daily living).

Pain assessments also consider the location of the pain, the onset and duration of the symptoms, a description of the pain (burning, squeezing, throbbing, aching, sharp), and factors that relieve or worsen the pain experience. A patient's attitude and willingness to adhere to a personalized pain management plan are key factors in the success of managing or alleviating the pain.

Some patients may be uncomfortable discussing their pain or pain score. They may have misunderstandings about opioid pain medications and may be concerned about side effects, which include nausea, vomiting, mental sedation, mental sluggishness, constipation or itching. Patients also may be concerned they will become addicted to the pain medications.

Pain medications are meant to blunt the body's physical sensation of pain, improve functionality and promote the body’s healing ability. When working with my patients, it is important that together we set reasonable goals for pain control and we adjust the management based on the patient's improvement and expectations.

Management of acute pain can be challenging. A pain management treatment plan should include integrative oncology services such as interventional pain procedures, multimodal pain medications, acupuncture, chiropractic care, massage therapy, physical therapy, nutrition therapy and mind-body-medicine.

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