“Tylenol and Ibuprofen did not work; we do not know what to do.”

“My child has rested, her tests are normal but her pain is worse, what is wrong?”

Have you ever uttered those words? You are not alone.

When most of us think of pain, we think of a fever or a joint sprain — pain caused by inflammation for which Tylenol and ibuprofen may help. But what if the pain is not caused by inflammation?

Chronic pain is pain that is not driven by organ or tissue damage. It is driven by altered signaling within the nervous system which is not picked up through labs or imaging. It is common to have normal labs and imaging in the setting of chronic pain. It often does not respond to over the counter pain medication. Medication alone does not help. It requires different types of therapy for treatment.

The words “acute” and “chronic” may make you think that chronic pain is just a continuation of acute pain but this is not true. Acute pain is caused by tissue damage. Chronic pain is when the pain signaling itself is altered. Acute and chronic pain are completely different!

Many people apply acute pain strategies for chronic pain and find chronic pain worsening.

Pairing the right type of therapy with the type of pain is necessary for treatment.

Acute pain treatment strategy Chronic pain treatment strategy
Rest/spending time in bed Activity/spending time out of bed
Medication based Use of cognitive, physical therapy; +/-medications
Use of brace, sling, crutch, or wheelchair Strengthening muscles through physical therapy so no assist device is needed

Sometimes the lines between acute and chronic pain are blurred. For example, an injury causes acute pain but if pain is still felt after the tissue has healed, chronic pain has developed.

For this reason, if you have concerns about your child and pain, please seek a pediatric pain specialist near you. All pain is not all the same.

How much do you know about pain and pediatric pain medicine? Take our pain quiz and find out!

Not all pain is the same infographic

Download our pain infographic here.


Elisha Peterson Elisha Peterson, MD, FAAP, is a board certified pediatric anesthesiologist and pain medicine physician.

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