Every nurse must be able to distinguish between acute and chronic pain. While the etiology and pathophysiology of acute pain differs from that of chronic pain, the goals and principles of acute pain management are not the same as they are for the management of chronic pain. Fishman, Ballantyne, and Rathmell (2010) describe acute pain as a normal neurophysiological response of the human organism to external stimuli. Such stimuli can be mechanical, chemical, or thermal (Fishman et al., 2010). Acute pain is usually limited in time and declines, as soon as the external stimuli are eliminated (Fishman et al., 2010). Oftentimes, it is associated with medical diseases, trauma, or invasive procedures (Fishman et al., 2010). By contrast, chronic pain is that which “persists beyond either the course of an acute injury or illness or its expected time for healing and repair” (Fishman et al., 2010, p. 699). Korff, Ormel, Keefe and Dworkin (1992) recognize chronic pain as a widely spread medical and health issue. It can be divided into several subgroups, including nocigenic, behavioral, and neurogenic pain (Hardy & Hardy, 1997). Changes in the physiology and patterns of acute and chronic pain imply considerable differences in how this pain should be managed.
According to the American Pain Society (n.d.), acute treatment goals include: early intervention, pain reduction, and effective recovery from the injury or disease that causes acute pain. Various therapeutic strategies are used to relieve acute pain, and they can be pharmacologic or nonpharmacologic. Pharmacologic treatment is still at the core of most, if not all, strategies for acute pain management (American Pain Society, n.d.). Nonpharmacologic approaches should never replace analgesics, but they have the potential to become an effective supplement to the pharmacologic strategies used to deal with acute pain. Imagery and relaxation can speed up the process of physical and emotional recovery after acute pain.
One should mention a difference between somatic and visceral pain. While many disorders result in somatic pain, the complexity of visceral pain should not be ignored. To a large extent, visceral pain presents a serious challenge to nurses and physicians. The most challenging are the cases, in which somatic pain and visceral pain come together. Leppert and Peipert (2004) list the following sources of somatic pain: pelvic and abdominal muscles, parietal peritoneum, fascia, skeletal system, and others. The origins of somatic pain are often found in inflammation, and such pain is located directly within the inflamed area (Leppert & Peipert, 2004). Somatic pain is aching, steady, and easy to define and describe. For that reason, nurses usually have few difficulties dealing with it. However, while somatic pain is well localized, visceral pain has vague localization. Its origins and causes may include but are not limited to inflammation, secondary ischemia, infection, neoplasm, or hemorrhage (Leppert & Peipert, 2004). For example, in the case of abdominal pain, visceral pain can be associated with the inflammation of the gallbladder, appendix, pancreas, liver, or uterus. Consequently, nurses may need additional time and laboratory tests to find out the source of visceral pain.
Unfortunately, contemporary medicine still lacks effective mechanisms to deal with visceral pain. At the same time, given that visceral pain remains the most common type of pain currently experienced by humans, it is high time for physicians, nurses, and researches to unite and develop new revolutionary strategies to combat visceral pain. Furthermore, new strategies to diagnose the sources of visceral pain are needed as well. Due to the fact that visceral pain is not well localized, the risks of medical errors remain quite high. Still, the current nursing practice provides enough resources to deal with the most complicated cases of pain.