Pain in the Acute State of Inflammation

Pain in the acute stage of inflammation is widespread (not localized) and the area feels red, hot, swollen and painful.
Edema (swelling) is a hallmark of this stage, as white blood cells are streaming to the injured area and fluid follows along into interstitial (between the cells) spaces.

The goals of acute inflammation are:

• to dispose of microbes, toxins and foreign materials
• to prevent their spread
• and to prepare the site for tissue repair

Physiology

Initially, blood vessels constrict in the area of injury: this helps slow metabolism.  This Vasoconstriction is accompanied by clotting in the vessels, which seals off the wounded site.  After 5 or 10 minutes, though, vasoconstriction is replaced with vasodilation (widened blood vessels), activated by chemical messengers like histamine, leukotrines, prostaglandins and cytokines.

Vasodilation allows blood to get to the damaged area quicker and increases permeability (so white blood cells (WBC's) and clot forming chemicals move in) to the site (diapedesis), Generally, within an hour after injury, phagocytes ("eating cells" - WBC's) move into the scene. Increased permeability also means that fluid and cellular debris can seep out of blood vessels more easily, The initial discharge lasts 24 to 36 hours.  When vasodilation is complete, blood flow decreases and blood gets thicker, allowing leukocytes to slow down and adhere to vascular walls (margination). Platelets stick to this exposed collagen. Thrombin causes fibrinogen to change into very sticky fibrin which further cements the clot. Clot formation begins 12 hours after injury and is completed within about 48 hours.

Pain treatment in the Acute SOI  focuses on keeping the inflammation response from running amok and causing more damage to the area.

The Symptom Picture is :

• SHARP signs (Swelling, Heat, A loss of function, Redness and Pain)
• Elevated Sympathetic Nervous System (SNS) Response ("fight, flight or freeze")
• Muscle spasms (muscles contract to protect against trauma)
• Possible bruising
• Pain is diffuse and felt early in movement

Treatment Plan (works to decrease the symptoms. Therefore

• Decrease SHARP signs (except for A loss of function- - as the body is now guarding to protect the site of injury)

                  clear edema, and accompanying heat and redness
                  reduce pain

• Treat the compensatory structures (the other side of the body which is working hard to take the load of the injured side)
  
• Reduce the Flight or Flight response (general relaxation and calming tensed nervous system preparing for danger
  

Treatment follows directly from the Plan, So

• Use Ice to decrease SHARP signs
  
• Use MLD (manual lymph drainage) to decrease SHARP and fight or flight response
  
• Swedish (avoiding the site of injury and areas distal to it) also increases the relaxation response
  
• as does DDB (deep diaphragmatic breathing) 
  
• Massaging the opposite side will treat the compensatory structures, and massaging proximal to the injury will also help push circulation back to the heart, speeding the removal of toxins from the injury
  

Self Care Recommendations follow the Plan too, so good recommendations include

• PRICE (protect, rest, ice, compression and elevation) of hurt area
  
• DDB
  
• some gentle movement (if there is no pain and inflammation is mitigated) such as range of motion ROM in an ice bucket
  

Hydrotherapy:  Ice or if the patient cannot stand the extreme temperature, Cool - to soothe the red, hot, painful, swollen area

Contraindications include:

• Do not massage within one inch proximal to the injury (so as not to redamage the compromised area)
  
• Fever (a sign of systemic inflammation and damage)
  
• Infection  (a sign of widespread inflammation and damage)
  
• recognize that Pain Medications can affect the patient's perceptions of pressure that may be causing more damage, so try to get clients to space these out and take the next dose after, rather than right before a session