Another whining moaning hypochondriac? So Just What is Acute Pain?

Whining and moaning? Yes, maybe.
Hypochondriac? No. I prefer to say “misunderstood”.

I’ve have though decided to do something about it since it recently occurred to me that I don’t have a choice. I was literally going crazy with all that was going on in my life as my wife (also known locally here as ‘the angel’), will verify.
By creating an online journal about how I am dealing with my Chronic Pain, I’m hoping that (1) It helps me and (2) that it might hope someone else in a similar position.  It will take a few weeks (or months) before it develops an identity and hopefully a sense of direction. I can only apologise up front for the apparent randomness that will be presented to you when you visit the site until such time I decide on a clear path on my road to recovery, (assuming some other bugger doesn’t keep moving all the signs).

I’ve known for a few years now that I’ve been in pain. Sounds daft I know, because it bloody well hurt and it continues to hurt, but what I didn’t know was that I was suffering from Chronic Pain. I didn’t really understand what Chronic pain was.

Image via Wikipedia

What I had not realised however was there is a distinct difference between “acute” and “chronic” when it comes to pain.

Acute Pain and Chronic Pain. What is it?

Think of that little paper cut you’ve had before on the end of your little pinky when folding a sheet of A4/Letter paper. It hurt like hell compared to the time you broke you ankle falling off your bike in the back yard.  A broken ankle sounds like a much more serious injury compared to the paper cut, so why is it that we sound like we are dying a nasty death with the paper cut, but want to carry on cycling/running around when we break our ankle?

Note: I’m talking about a minor broken ankle here, not some “compound dislocated fracture” or similar.  I’m also assuming that you didn’t actually attempt to go cycling/running on the broken ankle as that might have changed your opinion on just how painful it was.

Apart from the obvious medical reasons that go some way to possibly explain , such as for example a greater number of nerve endings near the surface of the skin on the finger, compared to those surrounding the ankle bone, there is also the fact that we can see the injury.
Think back to the days when you were younger.  You’d come running in from the back yard and your mum would scream at the sight of the blood running down your head from a deep cut you’d suffered falling off your bike many hours earlier. Now despite the fact it had happened several hours ago and it hadn’t bothered you one bit because you hadn’t noticed it before, it was only after your mum had pointed it out to you and had ran to the bathroom and seen it in the mirror for yourself, that you went into a frenzy and attempted to convince the world your life was over and you’d had it. So there is also the visual aspect of an injury. We can see the effect of the paper cut more so than the initial injury to the ankle.

We are often asked by staff working in the medical profession, “on a scale of 0 – 10, 0 being no pain at all and 10 being the worst pain imaginable, how would you describe your pain?”
For some strange daft reason, the majority of people would swear that the paper cut to the finger would score higher than the broken ankle.  Medically, that is because the paper cut causes a higher level of ‘acute’ pain than the broken ankle. 
The point here is that both injuries cause ‘acute’ pain, just at different levels.

Within a relatively short time, the paper cut which started out life scoring a massive 10, it rapidly works its way back down to 0. With any luck, the skin heals over leaving the faintest of scars (if at all), and you’ll not be reminded of it ever again.
Our ankle injury too eventually travels back down towards 0, but this is where we start seeing a difference to our apparently more painful paper cut. 

As the swelling on our ankle develops, the level of acute pain may well increase from its initial value. After having the ankle placed into a cast, we might develop other pains associated with the initial injury such as itching, so now we have two sources of pain to contend with, but they are still incidents of ‘acute’ pain.  Many months after the cast has been removed, the bone solidly repaired, it begins to develop a dull ache during the winter months as the onset of mild arthritic pain begins to form.
As is often the case with broken bones particularly around joints, arthritis can form many months or years after the initial injury. And again, this still causes a finite level of ‘acute’ pain.  Unlike our initial ankle injury though, this isn’t going to go away.  We can manage the pain, but most likely we are going to be stuck with it.  It won’t be that “man flu like”  10 out of 10 pain from our paper cut and it might well only be a 1 out of 10 most of the time, or a 2 to 3 out of 10 during really cold spells, with the occasional 8 to 9 for a few seconds once in a blue moon for some unknown reason.

It will initially feel no where near as bad as our paper cut nor the original ankle injury but then time takes over.  The pain always seems to be there, and it’s there when you don’t want it to be there.  It’ll be there when you want to go to sleep. The dull ache and throbbing that usually on it’s own wouldn’t even make a 1 out 10, but because you’re in bed trying to get to sleep, it’s there banging away like a drum, making no noise, yet keeping you from your sleep.
You’ll be sat at your desk writing that report, when the dull throbbing takes over, breaking your concentration and you need to go walk it off or go pop a few painkillers.
Despite the fact that it very rarely reaches an acute pain level above a 1 or 2 out of 10, it is there constantly, 24 x 7, 365 days a year for the rest of your life.
You can’t escape from it, ever.
When someone asks you many years later how the ankle is, you’ll say, “Oh, it’s fine, I can’t even feel it now. Just a slight bump where I banged it”, despite the fact you haven’t slept for the past week because it’s been snowing and the cold weather has increased the throbbing to a massive 2 out of 10. But it’s there, constantly reminding you of the day you fell off your bike 30 years ago.

Now the pain begins to traverse from ‘acute’ to ‘chronic’.

How ‘acute’ pain effects each person is different.
How ‘acute’ pain is measured by each person is different.
Each 0 – 10 scale is different, since where there may only be a finite number of points between 0 and 10, the effect and value of pain at each level is different from person to person.
One mans 5 is another mans 2 is another mans 8.
‘acute’ pain is personal.

“Chronic” pain however is different in that it is an ‘effect’.
“Chronic” pain effects each person differently.

So I don’t think I’m a moaning, whining hypochodriac.  I’m much worse.  I’m a guy who has suffered from “chronic” pain for the past 7 years, I have an internet connection, a link to Google, and I’m not afraid to use it.
Whereas I can clear the cache of my browser once I’ve finished my research, if I could only convince my brain to forget about “chronic” pain, I’d be cured and I’d get my life back.
If only eh?