Q. After a fall, I developed pain in my right neck that radiated to my right shoulder. It has been six months, and the pain persists. What can cause this type of pain?
A. Scientists, researchers, and pain experts continue to explore what causes acute pain from an injury to become chronic pain. But first, what is the difference between acute and chronic pain?
Many physicians, myself included, have used time frames to define the two types of pain: acute pain lasts two to three weeks, chronic pain lasts two to three months or more, and sometimes becomes permanent. The origin of the pain is also different. Most acute pain is related to tissue damage and is called nociceptive pain. Chronic pain is called neuropathic pain, which may have started with a damaged or irritated nerve, but whose pain signals are now coming from the brain (for more information, see “Stopping pain before it becomes chronic”).
So let’s look at your situation from a different angle than the duration of pain. I will make some assumptions about your fall to provide context for understanding this prevalent scenario. The first question is whether your chronic pain is related to persistent tissue damage caused by the fall. Most cases of tissue damage resolve within a few weeks, but unrecognized nociceptive pain may still be present. But in your case, there does not appear to be any persistent neck or shoulder injury. However, in situations like yours, many physicians will still focus on the source of the peripheral pain.
For example, your doctor may recommend an injection of a local anesthetic to relieve the pain temporarily. However, it may come back because chronic pain has a central origin, probably in the brain. Thus, the approach to chronic pain is more effective if it focuses less on the duration of pain and more on its origin: nociceptive (tissue) or neuropathic (mainly in the brain), and often both.
