Dolor musculoesquelético agudo frente a crónico: ¿cuál es la diferencia?

Si te golpeas la espinilla contra la esquina de la cama, ya conoces el dolor agudo que puede producirse. Y si eres una persona que padece continuamente dolor de espalda o artritis de rodilla, por ejemplo, es posible que conozcas un dolor profundo que persiste durante semanas, meses o incluso años. La diferencia entre ambos es lo que suele denominarse dolor agudo frente a dolor crónico. 

El dolor agudo, que suele resolverse en poco tiempo, suele tener un desencadenante conocido, como una lesión, pero en algunos casos puede aparecer sin motivo evidente. Lo mismo ocurre con el dolor crónico. A menudo está relacionado con una afección diagnosticable, como la artritis, pero también puede surgir al azar y persistir mucho después de que se haya tratado un problema precipitante, como un hueso roto o un tirón muscular. 

"El dolor es complejo y multifactorial", dice Kristin Vinci, PT, DPT, fisioterapeuta de Hinge Health. Tanto si tu dolor empezó hace poco como si llevas luchando bastante tiempo, hay muchas estrategias que pueden ayudarte a aliviar tus molestias y, lo que es más importante, a mejorar tu calidad de vida en general.

Sigue leyendo para saber más sobre el dolor agudo y crónico y sobre cómo tratar ambos, con ayuda de nuestros fisioterapeutas de Hinge Health.

What Is Pain?

Pain — whether it’s short-term (acute) or long-term (chronic) — is defined as physical and emotional discomfort that’s associated with actual or potential tissue damage. 

But understanding pain and how you experience it is not as straightforward as it seems. It can be helpful to remember that pain can be a good thing when it’s a useful and necessary response to injury, acting like a warning light on your body’s dashboard telling you that something in your body needs attention. “Pain is an ongoing conversation between your body, your nervous system, and your brain,” says Dr. Vinci.

What makes pain complicated is that how you experience it varies based on a combination of biopsychosocial factors, including your genetics, emotions, beliefs, lifestyle habits, stress level, social connections, and overall physical and mental well-being. These factors, with the exception of your genetics, can change over time which, in turn, means your pain response won’t always be the same.

Think about what happens if you’re stressed at work while also dealing with chronic neck pain. You may clench your jaw and neck muscles without realizing it, take less work breaks, skip your usual lunchtime walk, and sleep less soundly. How much your neck pain hurts can be impacted by many of these variables, says Dr. Vinci.

It’s also important to note that pain can sometimes arise (and linger) when there isn’t any obvious trigger present. In these instances, the problem often is less about one specific thing that happened to cause your pain, and more about many different factors that are contributing to your body’s pain response.

What Is Acute Pain?

Acute pain is defined as pain that lasts for a short period, up to three months, says Dr. Vinci. While you might think of acute pain in terms of intensity (sharp, throbbing, etc), the terminology is actually only meant to indicate duration. While acute pain can be intense, it doesn’t have to be, says Dr. Vinci. It’s often localized, meaning it's confined to a relatively small area of the body that you can identify. 

There’s a long list of possible reasons for acute pain. Maybe you sprained a ligament at the gym, burned your hand on the stove, fell and broke a bone, or were in a car accident. In short, anything that hurts causes acute pain — provided it resolves within three months. But as noted earlier, there isn’t always an obvious trigger. Acute pain can also be protective, warning you to modify your behavior to avoid injury. 

What Is Chronic Pain?

If your pain persists for more than three months, it’s considered chronic. As with acute pain, the definition of “chronic pain” only refers to the timeline. Chronic pain can be severe or mild, achy or sharp, localized or widespread.

Acute pain transitions into chronic pain once you pass the three-month mark, says Dylan Peterson, PT, DPT, a physical therapist at Hinge Health. For instance, if you hurt your back, the pain would first be defined as acute. But if the discomfort lasts longer than three months, you’d now have chronic back pain.

But there doesn’t have to be an acute injury that precedes chronic pain. Chronic back pain is a good example of this. About 16 million American adults have chronic back pain — and most of the time there isn’t an injury or disease that’s singularly responsible, says Dr. Peterson. It is almost always a combination of factors.

We often compare pain to an alarm or warning signal that helps you know what to do (or stop doing). We want alarms that are clear, consistent, and calibrated, like when your car beeps at you to put on your seatbelt. These types of pain signals in the body help you to know what is helpful and safe. 

But chronic pain can have pain alarms that are inconsistent and unclear. Many people with chronic back pain, for example, might finish a helpful exercise session only to have their pain flare up, leaving them wondering, Did I do something wrong? Did I hurt myself? In these cases, we often have to look beyond the pain to answer these questions because the pain alarm is not as useful or well calibrated. The body’s pain system has become over-protective. While your pain response is still important to guide care, it might be less useful at answering certain questions surrounding why your pain won’t go away.

Even when you can’t pinpoint why you’re in pain, that doesn’t mean it’s “all in your head.” Any chronic pain you’re feeling is very real, no matter how long it’s persisted or whether a specific cause can be found.

Still, we know that not having a clear answer to why you’re in pain can be frustrating, especially when dealing with chronic pain. But you don’t have to live with the discomfort — there’s a lot you can do to help improve chronic pain symptoms and still enjoy all your favorite activities.

How to Treat Acute Pain

There are many possible causes of acute pain, so treatment has to be tailored to each person, says Dr. Vinci. But when it comes to most types of acute musculoskeletal pain — such as joint pain or strained muscles — treatment usually follows the same general principles. While you may be familiar with the R.I.C.E. (rest, ice, compression, and elevation) approach to pain relief, there’s a more updated treatment strategy — P.E.A.C.E. and L.O.V.E. — that prioritizes gentle movement and activity modifications for soft-tissue injuries.

If acute pain is caused by a specific soft tissue injury, such as overdoing it at the gym, start by focusing on PEACE:

• Protect the injured area by scaling back on activities that cause pain in the first few days after injury — but don’t avoid movement entirely. 

• Elevate the injured area above your heart to reduce swelling.

• Adjust anti-inflammatories, like ibuprofen. It’s best to limit their use, as high doses can impact tissue healing. But if you’re in a lot of pain or your symptoms are limiting your function and movement, talk to your doctor about whether it’s safe for you to use them. 

• Compression. If it hurts to move the injured area, a gentle compression wrap may help for the first few days or weeks after injury. Just make sure you exercise without the wrap as you strengthen the affected area. 

• Education. Listen to your body. It will tell you when an activity is too much for the affected area. A physical therapist can help you tune in to these clues, too.

After a few days, as pain subsides, LOVE becomes the rule, says Dr. Peterson:

• Load the injured area by gradually returning to normal activities, using pain as your guide. Know that some pain during or after activity is okay, but your pain should not exceed an acceptable level for you. At the gym, this may look like starting back with less weight when you do certain moves.

• Optimism. It’s natural to get discouraged when you’re injured, but maintaining the belief that you have the capacity to heal and can return to meaningful activities is a critical component of healing. Simply believing that you will get better really does matter.

• Vascularization means increasing blood flow to the injured area by engaging in exercise you can handle. This may even reduce the need for pain medication.  

• Exercise, or an active approach to recovery, restores mobility and strength. You can use pain as a guide to gradually progress your exercise and increase difficulty. For new-onset acute pain, a physical therapist can evaluate you and rule out anything before recommending independent exercise, says Dr. Vinci. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

How to Treat Chronic Musculoskeletal Pain

Chronic musculoskeletal pain can be frustrating and feel limiting, especially when it persists or interferes with your daily activities. While it can take an obvious toll on your physical health, its effect on your mental health can’t be understated. Chronic pain can significantly impact one’s quality of life. That’s why treating chronic pain typically requires a multi-pronged approach, says Dr. Vinci. Some strategies to consider:

Increase your movement. Many people understandably worry that exercise will make their chronic pain symptoms worse, may not be safe, or do more damage. All of these are myths. In fact, being sedentary is associated with worsening pain symptoms. Movement is often the fastest way to symptom relief. As our Hinge Health care team says, movement is medicine. The key to getting moving is to ease into exercise so you can teach your body that it's safe and healthy to move, says Dr. Vinci. “Over time, you’ll be able to do more without increasing your pain and you may even lessen it,” she says. Keep in mind that it’s okay if your pain temporarily increases a little while you’re getting used to moving again. A physical therapist can help guide you.

Practice healthy lifestyle habits. In addition to getting regular exercise — and following a physical therapy program that aims to stretch and strengthen areas of your body that need extra attention — make sure you’re sleeping enough, eating well, and managing your stress. “Anything that improves your overall health can help,” says Dr. Vinci. The reverse is also true: “If you’re not sleeping well, your nutrition is off, and you’re stressed out, it can turn up the volume on the pain you’re feeling.” That said, adopting a healthier lifestyle can feel challenging when you’re dealing with chronic pain. Remember: Even small changes can have a positive effect on your overall well-being.

Consult a psychologist or licensed social worker. The pain you feel is real, but your mental state and outlook play an important role in how you feel and function. A counselor trained in cognitive behavioral therapy (CBT) can help you reframe negative thoughts and limiting beliefs. The goal is to help you recognize negative or distressing beliefs you may hold, so you can challenge them and replace them with more positive and helpful ones. CBT can also help address any anxiety or depression you might have, as these issues often coexist with chronic pain.

PT Tip: Don’t Be Deterred by Discomfort

Whether you have acute or chronic pain, don’t let a little discomfort deter you from activity, says Dr. Vinci. “A small increase in pain while you’re moving is okay, and in the long-term it’s going to bring down your baseline sensitivity,” she says. That means, as you exercise more and get stronger, moves that used to hurt should start to feel easier. “People think that if something hurts they shouldn’t do it,” she says, “but a little pain is normal and expected. It doesn’t mean that you’re making your issue worse.”

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Dolor agudo. (2021). Asociación Internacional para el Estudio del Dolor (IASP).https://www.iasp-pain.org/resources/topics/acute-pain/

2. Dolor de espalda crónico. (s.f.). Instituto de Política Sanitaria. Obtenido dehttps://hpi.georgetown.edu/backpain/

3. Terapia cognitivo-conductual para el tratamiento del dolor. (2 de junio de 2022). Kaiser Permanente. https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.cognitive-behavioral-therapy-for-pain-management.tv3092

4. Dubois, B. y Esculier, J.-F. (2019). Soft-tissue Injuries Simply Need PEACE and LOVE (Las lesiones de tejidos blandos simplemente necesitan PAZ y AMOR). British Journal of Sports Medicine (Revista británica de medicina deportiva), 54(2), bjsports-2019-101253. doi:10.1136/bjsports-2019-101253

5. Hill, P. (2018). Dolor crónico: consecuencia de una acción protectora desregulada. British Journal of Pain, 13(1), 13-21.doi:10.1177/2049463718799784

6. Osterweis, M., Kleinman, A., & Mechanic, D. (2019). Anatomía y fisiología del dolor. Nih.gov; National Academies Press (EE.UU.).https://www.ncbi.nlm.nih.gov/books/NBK219252/

7. Rankin, L. (2020). ¿Qué es el modelo biopsicosocial del dolor? Federación Europea del Dolor.https://europeanpainfederation.eu/what-is-the-bio-psycho-social-model-of-pain/

8. Rikard, S. M. (2023). Dolor crónico entre los adultos - Estados Unidos, 2019-2021. MMWR. Informe Semanal sobre Morbilidad y Mortalidad, 72(15).doi:10.15585/mmwr.mm7215a1

9. Treede, R.-D. (2018). La definición de dolor de la Asociación Internacional para el Estudio del Dolor. dolor Reports, 3(2), e643.doi:10.1097/pr9.0000000000000643