Is Acute/Chronic Pain a Continuum? Some pain is straightforward – you bang your hand with a hammer, it’s acute pain where you know the cause. Some pain is mysterious – we understand why fibromyalgia causes pain and fatigue only in peripheral glimpses: inflammation, viral predispositions, micronutrient deficiencies, perhaps? Complex regional pain syndrome (CRPS) is even more enigmatic, where a known acute event lingers long past the cellular stigmata. And as anyone with chronic back or neck pain knows, one literal misstep can layer acute pain on the chronic area, requiring both acute icing and a return to chronic pain patterns. Chronic Pain Versus Acute Pain Responses In many ways, the distinction between chronic pain and acute pain arose as an arbitrary attempt to match conditions with pharmaceuticals. Pain organizations have dictated that chronic pain deserves the label at three months, then at one. Some now say that after seven days, acute pain can be in transition to chronic pain. Often these arbitrary distinctions helped guide when one considered gabapentin, or when opioids are no longer excusable. In light of recent research, are they still relevant, or even accurate? The emerging understanding of the brain as the site of pain has

Translating New Pain Management Research Part 1: What Is Pain? Imagine hitting your hand with a hammer. Since the discovery of the nerve, pain has been portrayed as an impulse traveling from hand to head, with concrete implications: if you can stop the transmission in the hand, as with lidocaine, there is no pain. If you can block pain in the spine, the brain is blissfully unaware. And most recently, if a medicine blurs the reception of pain in the brain, the problem is solved. Pain is an alarm system that can be short-circuited. New Pain Management Studies New functional MRI (fMRI) studies have changed the way we understand nociception (perception of noxious stimuli). Instead of an all-or-none pain bolus from the periphery in a tidy 0-10 rating, pain is a nuanced interpretation of both the stimulus and the context. Being knocked to the ground in an attack can be a scary, painful event. When you’ve just caught a football and you’re tackled in the end zone, pain is irrelevant. When a child is awaiting their third injection, the screaming may begin with a benign swipe of an alcohol wipe. New theories of pain have recast the nature of the