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CSM and Acute and Chronic Pain

What is Acute pain, compared to Chronic Pain?

Dr Abdul Lalkhen, 
Consultant in Anaesthesia and Pain Medicine, SRFT NHS Trust

When the body is damaged from an injury or illness; chemicals are released which trigger nerve signals to the brain. The brain makes sense of these signals and produces the experience of pain.

In acute pain, if we have treatment for the disease or injury, the pain settles when the body has healed.

Sometimes pain continues despite all healing having taken place… because the alarm system… has become faulty. We call this chronic pain.

Dr Abdul Lalkhen, Consultant Pain Medicine. MB.ChB FRCA FFPMRCA DP.Med(CARCSI) PGDip Med Ed

Sometimes the pain continues despite all healing having taken place and without ongoing injury or disease. This is because the alarm system which sends messages to the brain has become faulty. We call this kind of pain chronic or persistent pain. It can happen when the nerves in your spinal cord are damaged in a disease like cervical spondylotic myelopathy. When nerves are damaged they no longer behave normally and the short-circuit which occurs results in the unpleasant sensations that you experience. The sensations are not warning you about further damage.

Chronic pain is therefore any pain that has lasted for longer than six months (because most healing will take place by six months) despite appropriate treatment. It is not a dangerous pain but can be difficult to understand and manage on a day to day basis.

Pain medication offers 30-50% relief in chronic nerve pain for most patients and this must be balanced against unwanted side effects. The medications used are either anti-epileptic or antidepressant type medications which try to calm the short-circuiting nerves down. Pain clinics can offer advice on medication in the management of chronic pain.

Persistent pain can affect all aspects of our lives including activity, energy levels, general health and sleep. It can cause worry, frustration and low mood. It can impact on our ability to work and may affect relationships with family and friends. The main aim of pain management is not just pain relief but learning how to cope with the effects of persistent pain and therefore improve function and quality of life. A Pain Clinic therefore includes doctors, physiotherapists, nurses and psychologists. This holistic approach is similar to other long-term conditions like diabetes where the aim is not a cure but management of the effects of the disease.

Dr Abdul Lalkhen - Biography

Dr Lalkhen is a Consultant in Anaesthesia and Pain Medicine at Salford Royal NHS Foundation Trust.

The Pain Centre offers a range of pain management therapies including interdisciplinary rehabilitation within a biopsychosocial framework.

Dr Lalkhen leads the Spinal Cord Stimulator Service which focuses on neuropathic pain. He is also an Honorary Senior Lecturer at the Universities of Manchester and Salford.

Dr Lalkhen has co-authored the Clinical Anaesthesia Viva Book (2nd Edition) and published articles on statistics, non-obstetric pain in pregnancy, medicolegal aspects of anaesthesia and perioperative peripheral nerve injuries.

Further Reading