23 Acute Pain

Acute Pain

The International Association for the Study of Pain (IASP) states that “pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”. This definition represents a shift away from a pathoanatomical approach to contemporary view of pain recognizing that the experience of pain is multifactorial and is influenced to varying degrees by biological, psychological, and social factors (Raja et al., 2020).  Six new key notes go with this new definition of pain, they are:

  1. Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.
  2. Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.
  3. Through their life experiences, individuals learn the concept of pain.
  4. A person’s report of an experience as pain should be respected.
  5. Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being.
  6. Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain.


Acute pain can be a result of various conditions including post-operative pain, muscle strains, sprains, contusion, whiplash and nonsurgical fractures. Acute pain usually lasts less than 7 days, but can in some cases acute pain can last as long as 30 days (Kent et al., 2017).


A thorough health history intake can be done to gather information about patients’ limitations, course of pain, and prognostic factors for delayed recovery (e.g., low self-efficacy, fear of movement, ineffective coping strategies, fear-avoidance, pain catastrophizing) and answers to health-related questions. Screen patients to identify those with a higher likelihood of serious pathology/red flag conditions. Then undertake a physical examination: neurological screening test, assess mobility and/or muscle strength.

Incorporate one or more of the following outcome measurements when assessing and monitoring patient progress:

  • Pain Self Efficacy Scale
  • Patient Specific Functional Scale
  • Brief Pain Inventory (BPI)
  • Numeric Pain Rating Scale (NPRS)
  • Visual Analog Scale (VAS)
  • The Revised Short McGill Pain Questionnaire Version-2 (SF-MPQ-2)



Provide patient education on condition and management options and encourage the use of active approaches (lifestyle, physical activity) to help manage symptoms.

Manual Therapy

Ascribing patient’s pain solely a tissue-driven pain problem is often an oversimplification of a complex process. This insight provides us with an opportunity to re-frame our clinical models. Gently stretching the muscles, neurovascular structures, and investing fascia activates endogenous pain modulating systems that help to modulation neuro-immune responses. 

Self-Management Strategies

To avoid harms associated with drugs, multi-modal nondrug therapies for pain are becoming more widely used, including ice, heat, acupressure, transcutaneous electrical nerve stimulation, exercise, and mindfulness-based interventions (Brasure et al., 2019; Chou et al., 2020; Hsu et al., 2019; Qaseem et al., 2020; Shires et al., 2020).


Massage therapy as a therapeutic intervention is being embraced by the medical community. This is in part because it is a non-pharmacological therapeutic intervention that is simple to carry out, economical, and has very few side effects. Existing evidence suggests that massage therapy (soft tissue massage, neural mobilization, joint mobilization) can be used to help relieve pain, improve function, and reduce anxiety when integrated with standard care (Brasure et al., 2019; Chou et al., 2020). An interdisciplinary approach including patient education, self-management strategies and massage therapy based on shared-decision making and patient safety is best practice for acute pain management.

Key Takeaways

Contemporary multimodal massage therapists are uniquely suited to incorporate a number of rehabilitation strategies for acute pain based on patient-specific assessment findings including, but not limited to:

  • Manual Therapy (soft tissue massage, neural mobilization, joint mobilization)
  • Education that is Person-Centered (e.g., biopsychosocial model of health and disease, self-efficacy beliefs, active coping strategies)
  • Stretching & Loading Programs (e.g., concentric, eccentric, isometric exercises)
  • Hydrotherapy (hot & cold)
  • Self-Management Strategies (e.g., engaging in physical activity and exercise, social activities, and healthy sleep habits)

References and Sources

Bayer, M. L., Magnusson, S. P., Kjaer, M., & Tendon Research Group Bispebjerg (2017). Early versus Delayed Rehabilitation after Acute Muscle Injury. The New England journal of medicine, 377(13), 1300–1301. doi:10.1056/NEJMc1708134

Beecher, H. K. (1956). Relationship of significance of wound to pain experienced. Journal of the American Medical Association, 161(17), 1609–1613. https://doi.org/10.1001/jama.1956.02970170005002

Benedetti, F., Frisaldi, E., Barbiani, D., Camerone, E., & Shaibani, A. (2020). Nocebo and the contribution of psychosocial factors to the generation of pain. Journal of neural transmission (Vienna, Austria : 1996), 127(4), 687–696. https://doi.org/10.1007/s00702-019-02104-x

Brasure, M., Nelson, V. A., Scheiner, S., Forte, M. L., Butler, M., Nagarkar, S., Saha, J., & Wilt, T. J. (2019). Treatment for Acute Pain: An Evidence Map. Agency for Healthcare Research and Quality (US).

Busse, J. W., Sadeghirad, B., Oparin, Y., Chen, E., Goshua, A., May, C., Hong, P. J., Agarwal, A., Chang, Y., Ross, S. A., Emary, P., Florez, I. D., Noor, S. T., Yao, W., Lok, A., Ali, S. H., Craigie, S., Couban, R., Morgan, R. L., Culig, K., … Guyatt, G. H. (2020). Management of Acute Pain From Non-Low Back, Musculoskeletal Injuries : A Systematic Review and Network Meta-analysis of Randomized Trials. Annals of internal medicine, 173(9), 730–738. https://doi.org/10.7326/M19-3601

Caneiro, J. P., Roos, E. M., Barton, C. J., O’Sullivan, K., Kent, P., Lin, I., Choong, P., Crossley, K. M., Hartvigsen, J., Smith, A. J., & O’Sullivan, P. (2020). It is time to move beyond ‘body region silos’ to manage musculoskeletal pain: five actions to change clinical practice. British journal of sports medicine, 54(8), 438–439. https://doi.org/10.1136/bjsports-2018-100488

Caneiro, J. P., Bunzli, S., & O’Sullivan, P. (2020). Beliefs about the body and pain: the critical role in musculoskeletal pain management. Brazilian journal of physical therapy, S1413-3555(20)30407-X. Advance online publication. https://doi.org/10.1016/j.bjpt.2020.06.003

Caneiro, J. P., Alaiti, R. K., Fukusawa, L., Hespanhol, L., Brukner, P., & O’Sullivan, P. P. (2021). There is more to pain than tissue damage: eight principles to guide care of acute non-traumatic pain in sport. British journal of sports medicine, 55(2), 75–77. https://doi.org/10.1136/bjsports-2019-101705

Chou, R., Wagner, J., Ahmed, A. Y., Blazina, I., Brodt, E., Buckley, D. I., Cheney, T. P., Choo, E., Dana, T., Gordon, D., Khandelwal, S., Kantner, S., McDonagh, M. S., Sedgley, C., & Skelly, A. C. (2020). Treatments for Acute Pain: A Systematic Review. Agency for Healthcare Research and Quality (US). https://doi.org/10.23970/AHRQEPCCER240

Cohen, M. M., Smit, V., Andrianopoulos, N., Ben-Meir, M., Taylor, D. M., Parker, S. J., … Cameron, P. A. (2017). Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial. The Medical journal of Australia, 206(11), 494–499. doi:10.5694/mja16.00771

Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British journal of sports medicine, 54(2), 72–73. https://doi.org/10.1136/bjsports-2019-101253

Duchesne, E., Dufresne, S. S., & Dumont, N. A. (2017). Impact of Inflammation and Anti-inflammatory Modalities on Skeletal Muscle Healing: From Fundamental Research to the Clinic. Physical therapy, 97(8), 807–817. doi:10.1093/ptj/pzx056

Finnerup, N. B. (2019). Nonnarcotic Methods of Pain Management. The New England journal of medicine, 380(25), 2440–2448. doi:10.1056/NEJMra1807061

Giannitrapani, K. F., Holliday, J. R., Miake-Lye, I. M., Hempel, S., & Taylor, S. L. (2019). Synthesizing the Strength of the Evidence of Complementary and Integrative Health Therapies for Pain. Pain medicine (Malden, Mass.), 20(9), 1831–1840. doi:10.1093/pm/pnz068

Hunt, E. R., Baez, S. E., Olson, A. D., Butterfield, T. A., & Dupont-Versteegden, E. (2019). Using Massage to Combat Fear-Avoidance and the Pain Tension Cycle. International Journal of Athletic Therapy and Training, 24(5), 198-201.

Hsu, J. R., Mir, H., Wally, M. K., Seymour, R. B., & Orthopaedic Trauma Association Musculoskeletal Pain Task Force (2019). Clinical Practice Guidelines for Pain Management in Acute Musculoskeletal Injury. Journal of orthopaedic trauma, 33(5), e158–e182. doi:10.1097/BOT.0000000000001430

Kent, M. L., Tighe, P. J., Belfer, I., Brennan, T. J., Bruehl, S., Brummett, C. M., Buckenmaier, C. C., 3rd, Buvanendran, A., Cohen, R. I., Desjardins, P., Edwards, D., Fillingim, R., Gewandter, J., Gordon, D. B., Hurley, R. W., Kehlet, H., Loeser, J. D., Mackey, S., McLean, S. A., Polomano, R., … Terman, G. (2017). The ACTTION-APS-AAPM Pain Taxonomy (AAAPT) Multidimensional Approach to Classifying Acute Pain Conditions. The journal of pain: official journal of the American Pain Society, 18(5), 479–489. https://doi.org/10.1016/j.jpain.2017.02.421

Laumonier, T., & Menetrey, J. (2016). Muscle injuries and strategies for improving their repair. Journal of experimental orthopaedics, 3(1), 15. doi:10.1186/s40634-016-0051-7

Lee, J. Y., Walton, D. M., Tremblay, P., May, C., Millard, W., Elliott, J. M., & MacDermid, J. C. (2020). Defining pain and interference recovery trajectories after acute non-catastrophic musculoskeletal trauma through growth mixture modeling. BMC musculoskeletal disorders, 21(1), 615. https://doi.org/10.1186/s12891-020-03621-7

Lin, I., Wiles, L., Waller, R., Goucke, R., Nagree, Y., Gibberd, M., … O’Sullivan, P. (2020). What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. British journal of sports medicine, 54(2), 79–86. doi:10.1136/bjsports-2018-099878

Melzack, R., & Wall, P. D. (1965). Pain mechanisms: a new theory. Science (New York, N.Y.), 150(3699), 971–979. https://doi.org/10.1126/science.150.3699.971

Melzack, R., & Katz, J. (2013). Pain. Wiley interdisciplinary reviews. Cognitive science, 4(1), 1–15. https://doi.org/10.1002/wcs.1201

Miake-Lye, I. M., Mak, S., Lee, J., Luger, T., Taylor, S. L., Shanman, R., … Shekelle, P. G. (2019). Massage for Pain: An Evidence Map. Journal of alternative and complementary medicine (New York, N.Y.), 25(5), 475–502. doi:10.1089/acm.2018.0282

Moseley, G. L., Baranoff, J., Rio, E., Stewart, M., Derman, W., & Hainline, B. (2018). Nonpharmacological Management of Persistent Pain in Elite Athletes: Rationale and Recommendations. Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine, 28(5), 472–479. doi:10.1097/JSM.0000000000000601

Qaseem, A., Wilt, T. J., McLean, R. M., Forciea, M. A., & Clinical Guidelines Committee of the American College of Physicians (2017). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine, 166(7), 514–530. doi:10.7326/M16-2367

Qaseem, A., McLean, R. M., O’Gurek, D., Batur, P., Lin, K., & Kansagara, D. L. (2020). Nonpharmacologic and Pharmacologic Management of Acute Pain From Non-Low Back, Musculoskeletal Injuries in Adults: A Clinical Guideline From the American College of Physicians and American Academy of Family Physicians. Annals of internal medicine, 173(9), 739–748. https://doi.org/10.7326/M19-3602

Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., Keefe, F. J., Mogil, J. S., Ringkamp, M., Sluka, K. A., Song, X. J., Stevens, B., Sullivan, M. D., Tutelman, P. R., Ushida, T., & Vader, K. (2020). The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain, 10.1097/j.pain.0000000000001939. Advance online publication. https://doi.org/10.1097/j.pain.0000000000001939

Sakamoto, J. T., Ward, H. B., Vissoci, J., & Eucker, S. A. (2018). Are Nonpharmacologic Pain Interventions Effective at Reducing Pain in Adult Patients Visiting the Emergency Department? A Systematic Review and Meta-analysis. Academic emergency medicine: official journal of the Society for Academic Emergency Medicine, 10.1111/acem.13411. Advance online publication. doi:10.1111/acem.13411

Shires, A., Sharpe, L., Davies, J. N., & Newton-John, T. (2020). The efficacy of mindfulness-based interventions in acute pain: a systematic review and meta-analysis. Pain, 161(8), 1698–1707. https://doi.org/10.1097/j.pain.0000000000001877

Stern, B. D., Hegedus, E. J., & Lai, Y. C. (2020). Injury prediction as a non-linear system. Physical therapy in sport: official journal of the Association of Chartered Physiotherapists in Sports Medicine, 41, 43–48. https://doi.org/10.1016/j.ptsp.2019.10.010

Tucker, H. R., Scaff, K., McCloud, T., Carlomagno, K., Daly, K., Garcia, A., & Cook, C. E. (2020). Harms and benefits of opioids for management of non-surgical acute and chronic low back pain: a systematic review. British journal of sports medicine, 54(11), 664. https://doi.org/10.1136/bjsports-2018-099805

van der Gaag, W. H., Roelofs, P. D., Enthoven, W. T., van Tulder, M. W., & Koes, B. W. (2020). Non-steroidal anti-inflammatory drugs for acute low back pain. The Cochrane database of systematic reviews, 4, CD013581. https://doi.org/10.1002/14651858.CD013581

Wideman, T. H., Edwards, R. R., Walton, D. M., Martel, M. O., Hudon, A., & Seminowicz, D. A. (2019). The Multimodal Assessment Model of Pain: A Novel Framework for Further Integrating the Subjective Pain Experience Within Research and Practice. The Clinical journal of pain, 35(3), 212–221. doi:10.1097/AJP.0000000000000670


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Evidence-Based Massage Therapy by Richard Lebert is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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