Traumatic Pain

Traumatic pain is physical pain that persists after a traumatic injury, often continuing long after the body’s initial wounds have healed and sometimes lasting for months or even years.

Table of contents

• What Is Traumatic Pain?
• What Causes Traumatic Pain?
• Symptoms of Traumatic Pain
• Who Gets Traumatic Pain?
• How Is Traumatic Pain Diagnosed?
• Treatment Options

What Is Traumatic Pain?

Physical trauma refers to any form of bodily damage, including injuries from accidents or assaults. This can happen through impacts on the body such as car accidents or falls, blows to the head, or exposure to extreme temperatures, pressure, vibration, or chemicals^[2]. After receiving a traumatic injury, people often experience persistent pain that continues beyond the expected healing period^[6].

Traumatic pain can be either sudden and short-lived, or it can become a long-lasting problem. When pain persists after the physical injury has healed, this continuation is called post-traumatic pain, which typically results from nerve or tissue damage at or around the site of the original injury^[18]. The pain may last only a few months after the event, or it may linger for years.

Acute traumatic pain refers to the immediate pain experienced during and shortly after an injury. This type of pain is a natural warning signal from your body that tissue damage has occurred^[9]. In contrast, chronic pain is different because it persists long after the initial injury occurred and the body has healed. Changes can happen in brain chemistry and the way nerves are connected in response to an injury, causing the nerves to fire inappropriately and excessively. The brain interprets this as pain^[5].

There are two main types of physical trauma: blunt force trauma, when an object or force strikes the body with enough force to cause a concussion, deep cut, or broken bone; and penetrating trauma, when an object pierces the skin and creates an open wound^[8].

What Causes Traumatic Pain?

Post-traumatic pain after a traumatic injury is common. In many cases, chronic pain results from nerve damage caused by the trauma. This nerve damage is often the reason for persistent pain even after recovery from the physical trauma is complete^[8].

No trauma is too small to cause post-traumatic pain. Even a sprain can result in lasting discomfort. In fact, the nerve does not necessarily have to be damaged to cause pain. Sometimes, pressure on a nerve as a result of the injury is sufficient to cause pain that can range from mild to severe^[8].

Doctors do not fully understand why some injuries trigger chronic pain. However, it is believed that faulty communication between the central and peripheral nervous systems, as well as an inappropriate inflammatory response, may play a role^[8]. The more serious the injury, the greater the chances of experiencing chronic pain following the event. It is not just the injury that causes pain but also the healing process and inflammation^[2].

Several factors make the healing process more difficult and can make the injured area more susceptible to pain and re-injury. These include inadequate treatment that may cause delays in healing, lack of blood flow to the tissue around the injury, and having an underlying health condition like diabetes or arthritis^[18].

Symptoms of Traumatic Pain

Following a traumatic injury, some discomfort is expected. The pain can be mild to severe, and symptoms can change over time, varying from patient to patient^[8]. Common symptoms of physical trauma include migraines, gastrointestinal issues such as abdominal pain and bloating, exhaustion, racing heart, and shivering^[2].

The most common initial symptoms of post-traumatic pain include pain, swelling, redness, noticeable changes in skin temperature, and hypersensitivity, particularly to cold and touch^[8]. Patients often describe post-traumatic pain as “burning,” “an unpleasant tingling,” or “numbness,” which are symptoms that resemble other nerve pain conditions^[8].

Other symptoms may include:

• Continuous burning or throbbing pain, usually in an arm, hand, leg, or foot
• Changes in skin temperature—the skin may appear sweaty and then become cold
• Changes in skin color—the skin can appear white and mottled to red or blue
• Changes in skin texture—the skin may become tender and sensitive to touch, or appear thin or shiny in the affected area
• Changes in hair and nail growth
• Decreased ability to move the affected body part
• Joint stiffness, swelling, and damage
• Muscle spasms, weakness, and loss
• The pain can be worsened by emotional stress^[8]

For some patients, the symptoms go away on their own. However, in others, chronic pain and dysfunction can persist for months or years. If not diagnosed and treated early, post-traumatic pain may progress to increasingly disabling symptoms^[8].

Who Gets Traumatic Pain?

Two in three patients who experience a traumatic injury have chronic pain for at least one year after the injury^[5]. Trauma survivors who are women or who had untreated depression before injury are more likely to suffer from chronic pain^[5].

People who have experienced childhood trauma or suffer from post-traumatic stress disorder (PTSD)—a mental health condition caused by an extremely stressful or terrifying event—are 10 times more likely to experience chronic pain due to the mind-body connection. In other words, mental and emotional pain can manifest as physical pain^[5].

High-risk patients include older adults over the age of 65, those who experienced extreme pain during the trauma, patients with an increased hospital stay, and those who experience anxiety or depression^[18].

Several studies show that 60 to 70 percent of emergency room patients experience pain, and more than half of them express moderate or severe pain at triage^[9]. Unlike most types of arthritis, post-traumatic arthritis—inflammation in a previously injured joint—is more common in younger people, including children. It is also more common in athletes and other active adults, who tend to get injured more often^[17].

How Is Traumatic Pain Diagnosed?

Pain scoring and systematic assessment of pain on admission to the emergency department is a cornerstone of translating the best treatment strategies into practice. Pain must be measured with severity scales that are validated in clinical practice^[11]. Typically, a nurse or provider will ask you to rate your pain on a scale of 1 to 10^[5].

The diagnosis of traumatic pain involves a physical examination and may include imaging tests. Your healthcare provider will move your joint, ask you about your symptoms, and compare your joint and its range of motion to what it was before your injury, if possible^[17]. After the physical exam, you might need at least one imaging test, such as an X-ray, MRI, or CT scan^[17].

Treatment Options

Although primary care in emergency departments focuses on resuscitation, diagnosis, and treatment, pain assessment and management remains a critical element^[11]. Most people can treat post-traumatic pain at home, though some may require more advanced medical interventions^[17].

Self-Management at Home

Treating trauma pain can be done at home by incorporating healthy habits into your daily routine. Movement is the most important factor in increasing mobility, strength, and movement control. Short daily walks or swims are low-impact but have lasting positive effects on your body. With any kind of exercise, small steps are key. Increasing time and intensity too soon may have adverse effects^[18].

Heat therapy can help by placing a warm, moist towel directly onto the old injury to help relax sore muscles and increase blood circulation. Ice therapy involves placing ice packs on the area of injury to help numb the nerves, reduce inflammation, and relieve swelling around joints^[18].

Mindfulness practices like meditation, yoga, and breathing exercises can help you become more in tune with your body. Studies have shown that patients who use mindfulness as a treatment experience less activity in the parts of the brain that control pain messages^[5].

Medical Pain Management

Chronic pain is frequently less affected by the same medicines that treat acute pain. These medications may play a role, but treatment of chronic pain requires a more holistic approach^[5]. Good mental health and regular exercise have been shown to decrease chronic pain in trauma survivors. Treatment usually has many parts to it: counseling for psychological coping, physical therapy, regular primary care physician visits, and occasionally a pain management specialist^[5].

Pain relievers can include anti-inflammatory medications such as aspirin or ibuprofen^[18]. When selecting medications for trauma pain in emergency settings, the focus is on those that are least disruptive to hemodynamic status. A multimodal pain approach, which involves the use of two or more drugs with different mechanisms of action, plays an important role in the relief of trauma pain^[11].

Other treatments include steroid medication injections to reduce inflammation, and nerve block injections, which can offer immediate and long-term relief, though they may require multiple injections over time to be effective^[18].

Additional Therapies

Ongoing physical therapy is an option for patients suffering from trauma pain. Physical therapy can help increase mobility and movement, improve range of motion, strengthen muscles, and decrease stress^[18].

Relaxation techniques such as deep breathing and meditation help your body to relax, which can significantly ease pain. These practices work by sending a quiet message to your muscles to release tension and tightness^[25].

No medication or treatment plan will stop post-traumatic injury pain completely, but with proper care and management, many patients can find significant relief and improve their quality of life.