Pathophysiology of Acute, Chronic, and Referred Pain

Respond on two different days who selected different factors than you, in the following ways:

Share insights on how your colleague’s factors impact the pathophysiology of pain.

Suggest alternative diagnoses and treatment options for acute, chronic, and referred pain.

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Pathophysiology of Acute, Chronic, and Referred Pain

Acute pain is the body’s natural way of alerting one of something potentially harming the body. Acute pain can last seconds or up to three months. The chemical mediators that stimulate the pain must be removed for relief to occur. Physical manifestations might be hypertension, increased heart rate, dilated pupils, diaphoresis, and anxiety. Acute pain can be broken down into three categories; somatic, visceral, and referred. Somatic pain manifests from the skin, joints, and muscles; it can be dull or sharp and is the same as is seen in polymodal C fiber transmissions (Huether & McCance, 2017).

Visceral pain transmits from the C fibers and affects internal organs and body cavity linings. Visceral pain may be poorly localized and have the pain characteristics of gnawing, aching, intermittent cramping, and throbbing. Nausea and vomiting, along with hypotension, may occur with visceral pain. When visceral pain spreads or radiates away from the original site, it is classified as referred pain. Referred pain can be chronic or acute. Visceral and cutaneous neurons send impulses from the same ascending neuron; in this case, the brain cannot gauge the different sources of pain. Because more receptors are located on the skin, the pain is felt at a referred site instead of the original location (Huether & McCance, 2017).

Chronic pain is considered the pain that lasts 3-6 months or longer. Changes in the central nervous and peripheral systems that cause dysregulation of pain modulation and nociception processes are thought to be the culprit for chronic pain. Symptoms may manifest as those listed above for acute pain, in addition to psychologic and behavioral changes such as; difficulty sleeping and eating, depression, and avoidance of pain triggers (Huether & McCance, 2017).

Patient Factors

Gender and age differences can vary wildly regarding pain. Men are less likely to report pain than women; they report more control over pain and are less likely than women to use alternative treatments for pain. Women make up 46% of the American women that report pain daily; they are more likely to report back pain, headache, foot ache, and arthritis. Women identify stress as a cause of pain (Lewis, Bucher, Heitkemper, & Harding, 2017).

The differences viewed regarding pain between younger and older adults might be; pain belief and attitude, pain perception, social support, and pain-related coping. Age may increase the density of unmyelinated fibers within the peripheral nervous system; the functional integrity of neurons within the sensory system could be reduced. There is brain volume loss noted in the hippocampus and prefrontal cortex; the thalamus could be reduced controlling pain duration. There are mixed findings related to decrease and increase sensitivity to pain in the older adult population; this is in part due to the perception of pain at this age, duration, stimuli, and individual characteristics. Adaptive strategies seem to be popular among older adults for various reasons, they seem to have isolated “coping mechanisms” and do not want to be viewed as chronic complainers (Molton, Terrill, & Anderson, 2014).


Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Lewis, S.L., Bucher, L., Heitkemper, M.M., & Harding, M.M. (2017) Medical-surgical nuring assessment and management of clinical problems (10th ed.). St. Louis, MO: Elsevier

Molton, I. R., Terrill, A. L., & Anderson, N. (2014). Overview of persistent pain in older adults. The American Psychologist, (2), 197. Retrieved from


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