Acute vs. Chronic Pain: The Role of Family Nurse Practitioners

Many people will experience chronic pain sometime in their lives. A recent study by The Journal of the International Association for the Study of Pain found that more than 50 million adults reported pain either on most days or every day. Pain management is an important approach health care professionals including family nurse practitioners use to help patients control ongoing pain.

Pain can affect quality of life and become so debilitating that sufferers can’t function. It comes in different forms and doesn’t affect everyone the same way. Family nurse practitioners (FNPs) can determine if a patient is having acute vs. chronic pain to better understand their treatment options. Making the distinction between acute and chronic pain is ultimately how FNPs and other medical professionals can provide the best care for these conditions.

What Is Acute Pain?

Often sharp and intense, acute pain is easily identifiable as it relates to something specific such as:

• A skin burn or scalding
• Broken bone
• Head or body trauma
• Muscle pull or strain
• Friction-based pain (road rash, rug burn)
• Labor/childbirth
• Surgery

Fortunately, acute pain will eventually go away, and usually isn’t derived from a chronic condition. The pain is worse typically at the occurrence of the injury.

However, some forms of acute pain can transition into chronic pain if not properly treated. For example, tennis players may experience acute pain in their elbows due to overworking tendons. Playing in that condition over time may result in more severe tendon damage, leading to a chronic injury.

What Is Chronic Pain?

Chronic pain continues on an ongoing basis, normally longer than six months, and is usually associated with an underlying condition. Health care professionals may find treating chronic pain challenging because it can last much longer than the condition or injury, and be difficult to identify the underlying cause. However, chronic pain is often associated with some common conditions such as:

• Musculoskeletal issues resulting from years of poor posture, improper lifting techniques, obesity, injury, aging, or a congenital condition that causes a curvature of the spine.
• Diseases that cause muscle and/or nerve pain, such as rheumatoid arthritis, osteoarthritis, fibromyalgia, cancer, multiple sclerosis, or AIDS.
• Chronic pain from a previously incurred injury healing incorrectly and/or not being properly rehabilitated.

Unlike acute pain, chronic pain may result in other physical or emotional effects for its sufferers. Physical effects may include muscle pain and/or tension, limited mobility, low energy, and changes in appetite. The emotional effects can include depression, anger, or anxiety. Additionally, the incorrect diagnosis or treatment of chronic pain can cause further pain or long-term damage. Sometimes, chronic pain sufferers need to seek mental health treatment to cope with the lasting implications.

FNP Treatment Options for Acute vs. Chronic Pain

Although everyone’s pain and suffering are specific to them, FNPs can categorize a patient’s pain as either acute or chronic. After this initial categorization, the FNP will administer corresponding treatments.

For especially severe cases of acute pain, FNPs may directly use pharmacologic pain management methods that use anesthetics. For low-level chronic pain, FNPs may try alternative holistic methods that don’t involve medication.

Acute Pain Management

An FNP assessing acute pain uses the mnemonic device PQRST to guide the line of questioning with the patient that includes:

• P for provoking factors: What provokes the pain? What makes it feel better or worse?
• Q for quality: Is the pain sharp, throbbing, burning, etc.?
• R for region: Where exactly is the pain coming from on the body?
• S for severity: On a scale of 1 to 10, with 10 being the most extreme, at what number is the pain level at?
• T for temporal: Is the pain constant or does it come and go?

In certain scenarios, patients may experience too much pain to answer assessment questions, or be too young to understand them. In these cases, the FNP defers to the Wong-Baker FACES Pain Rating Scale to determine the pain level, which is particularly useful when treating children.

After an initial pain assessment, FNPs determine the best pain treatment. Depending on what the patient is experiencing, they may deliver any of the following methods of treatment:

• Nonpharmacologic pain management: Includes cognitive behavioral therapy (CBT) or cutaneous stimulation (stimulation of nerves via skin contact) and/or physical interventions. FNPs do not administer pharmaceuticals with this type of pain management. Instead, they’ll try methods such as distraction, guided imagery, meditation, or other relaxation techniques. They may also use massage, heat and/or ice applications, or contralateral stimulation.
• Pharmacologic pain management: Involves administering pharmaceuticals on a sliding scale depending on pain level and severity. On the low end of the pain scale (1 to 3 pain rating), FNPs may administer nonopioids such as nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and Tylenol. In the middle of the pain scale (4 to 6 pain rating), they may administer opioids such as codeine and hydrocodone. On the high end of the scale (7 and above pain rating), FNPs may administer local anesthetics and antidepressants to increase pain relief, block pain receptors, and improve mood.

FNPs closely observe patients to ensure that their pain levels are properly managed. With acute pain cases, such as a severe burn, broken bone, or deep wound, pain management is usually the first step before moving onto subsequent treatments.

Chronic Pain Management

Assessing and treating acute vs. chronic pain requires a different approach. Treating chronic pain is often more challenging because underlying issues make it either highly complex or incurable. An FNP often reviews a patient’s medical history to understand the underlying causes of chronic pain, which may have occurred over time.

However, even with something as complex and debilitating as chronic pain, FNPs can use a plethora of treatment options. FNPs often administer chronic pain treatment strategies to help patients manage their pain to continue with daily activities. In addition to traditional over-the-counter pain medications, treatment options include:

• Prescription medications, such as nonopioids, opioids, and adjuvant analgesics
• Surgical implants that provide pain relief
• Trigger point injections of local anesthetic or steroids
• Alternative therapies (cognitive, behavioral, or physical therapy)
• Exercise programs designed to release endorphins, improve sleep, and reduce pain levels
• Relaxation techniques
• Acupuncture and acupressure therapies
• Biofeedback
• Transcutaneous electrical nerve stimulation (TENS)
• Cannabis or CBD

With the current opioid epidemic, FNPs are making a concentrated effort to wean patients from prescription opioids due to their highly addictive qualities and established history of misuse. According to the U.S. Department of Health and Human Services (HHS), approximately 10.1 million people aged 12 or older misused opioids in 2019. Additionally, 1.6 million people misused prescription pain medications for the first time. FNPs may promote holistic methods as safe, healthy alternatives for patients dealing with chronic pain.

Develop the Nursing Skills Needed to Provide Effective Treatment to Patients

FNPs require specialized medical knowledge to properly assess and treat patients with pain. While differences exist in treating acute vs. chronic pain, FNPs should have the skills to help patients cope with either in both the short and the long term to ensure quality care delivery.

By enrolling in Norwich University’s online Master of Science in Nursing: Nurse Practitioner program and its Family Nurse Practitioner track, students can acquire the education and skills required to make a positive difference in family care and pursue their professional goals of becoming FNPs.

With courses such as Advanced Physical Assessment, Advanced Pharmacology, and Family Nurse Practitioner Clinicals, the program offers students the opportunity to take the first critical steps toward becoming FNPs capable of helping patients overcome both acute and chronic pain.