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Last updated: Wed, Feb 19, 2025
Medical care providers and pain researchers use several terms to distinguish pain based on its duration. "Transient pain" is pain that is here and gone. There is usually a first, sharp pain followed by a second pain that may be more intense. Then it quickly fades away.
If pain persists for more than seconds or minutes, it is usually because there is tissue damage. This is the case, for example, when you burn yourself. Skin and perhaps deeper tissues are damaged by the burn, and the pain persists roughly in proportion to the remaining tissue damage. This is called "acute pain." Common injuries have common life cycles (also called "natural history") and the expectation of a treating care provider is that acute pain should fade and disappear as the tissue repairs itself. (More about the expected healing cycle is presented in Injury, Inflammation, and Healing.)
When acute pain outlasts its expected duration, it suggests that a rethink is needed by the care provider. In many cases, it raises a suspicion that the tissue damage has been greater than was hoped. For example, knee pain may at first be attributed to overuse, but various types of joint damage may be suspected and investigated if the pain persists after a number of weeks. This again is expected in medical practice.
"Chronic pain" is a term that is used in several slightly different ways in the medical context. Pain may be classified as acute for up to 6 weeks, subacute from 6 to 12 weeks' duration, and thenceforth chronic.1 These distinctions based on duration are useful in medical practice, but are inadequate to cover pains that are recurrent (e.g., sickle cell disease or migraines) or progressive (e.g., chronic obstructive pulmonary disease, metatstatic cancer, or osteoarthritic conditions).2
The term "chronic" is often used in other ways than these duration-based definitions suggest. (Most sufferers in any case are far beyond the twelve-week or three-month milepost before they seek specialized medical help.) Chronic pain is commonly used to suggest a syndrome, a collection of symptoms and processes, that accompany long-term suffering.
Two features of long-term pain seem to inform this other meaning of "chronic pain." First is the idea of expected healing times. What is the explanation when a person's pain exceeds what the physician expects based upon their diagnosis? Multiple explanations have been offered for different pain conditions, ranging from psychological (the person's mind or personality) to medical (unknown or undetected pain generators) to neurological (explanations based on the functioning of the pain system). The competition between these ideas has generated much valuable knowledge, but has also resulted in a hodge-podge of explanations and treatments that can be quite hard on the sufferer.
A second feature of chronic pain that is embedded in this concept of a chronic pain syndrome is the acknowledged severity of the effects of chronic pain. In another statement by two pain psychologists, "...pain that extends over time...has an important impact on all domains of a pain sufferer's life. Persistent pain is so prepotent that psychological factors may come to play an even greater role in influencing the subjective experience, report, and responses."3 (Again, this is the view of researchers with a background in psychology. See A Rational Model of Emotion and Pain for a different perspective.)
"Chronic pain" is often used to designate the set of symptoms which accompany long-term pain that has resisted the treatments that current medical practice has provided. Because the care provider's problem is so difficult, because our pain system is so complex, and because much of what's happening is hidden from the provider, there is much room for misunderstandings and miscommunications that affect sufferers. The essential purpose of this work is to provide some perspective on these problems and how they affect pain sufferers.