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Lost in Translation – When acute pain becomes chronic pain

By Timothy Cocks Lost in translation 10 Feb 2014

Lost in Translation; stories, articles or information that appear in popular media and on the web that get it wrong (horribly at times) or try to grab attention; try to get your ‘clicks’ and ‘views’ in our electronic age, with fantastic headlines.

Far from being trivial, these are the stories that people in trouble, people that are looking for answers, looking for validation, looking for hope, looking for cures, looking for others that share their pain, looking for others that might just understand, looking for help, looking for… something, are reading.

These stories, no matter how much nonsense they contain can be powerful influences.  They can provide completely erroneous, but seemingly credible evidence for how much danger a person-in-trouble is in, drive up the sense of threat and act as powerful contextual cues to increase pain.

When Acute Pain Becomes Chronic Pain – from a website that promotes itself as a source of “Trusted information for back pain relief”

“It is critical for a doctor and a patient to have an understanding of the difference between acute pain and chronic pain. With acute pain, the pain is a symptom of injured or diseased tissue… Additionally, with acute pain the severity of pain directly correlates to the level of tissue damage.”

That last line is just plain wrong and biologically indefensible.  It promotes one of the most harmful and threat-increasing ideas about pain.

“Not all pain that persists will turn into chronic pain”

I’m at a loss as to what exactly this means.

“As pain moves from the acute phase to the chronic stage, influences of factors other than tissue damage and injury come more into play and influences other than tissue input become more important as the pain becomes more chronic.”

Ok, this is more subtle, and there are ideas here that are reasonably useful.  But how can pain move? It isn’t the kind of “thing” that can move. In fact its not really a “thing” at all in the sense of being an object.

But this reification of pain, embedded so firmly in our language, is deeply problematic and moves us away from an understanding of the nature of pain as a lived experience (Quintner et al 2008).

What happens when a person in trouble, looking for answers reads “the severity of pain directly correlates to the level of tissue damage“?  

I think we must, and we can, do better.



Quintner JL, Cohen ML, Buchanan D, Katz JD and Williamson OW (2008). Pain Medicine and Its Models: Helping or Hindering? Pain Medicine Vol 9, No 7 2008 



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  1. Well said. I’ll soon be doing a blog post on the problems those in the US have both spelling HIPAA properly, defining and understanding the two meanings of “acute” and speaking about pain itself in a sensible fashion. It might become a series, or, at least, should be.

  2. timcocks0noi

    Thanks Barrett. Will look forward to reading your post(s). For those of us outside of the US, could you elaborate on HIPAA further?

    1. It is a law now firmly established that controls what you’re allowed to say and write about any patient. Violations carry a $10,000 fine (I think) and have led to numerous attempts/procedures designed to protect privacy. Its acronym is commonly misspelled HIPPA, but it’s actually the Health Insurance Portability and Accountability Act. “Privacy” isn’t in the title and those that think there’s more that one “P” neither understand the law as they might, nor did they once work on Portage Trail or next to Portage County, as I have. When we “portage,” that’s when things get complicated.

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