Trauma pain is any pain resulting from a physical injury or wound caused by external force or violence. Because of its broad definition, trauma pain can result from a virtually limitless amount of injuries. Similarly, the degree to which pain is experienced as a result of trauma can also vary from minor to severe, depending on the nature of the injury or wound.

Complications associated with acute trauma are among the leading causes of death and disability in the United States, especially in young people.

Nociceptors (nerve endings) play an important role in interpreting trauma pain. They first draw attention to the injury, then transport information from the injured location to the brain where it is translated into pain. Nociceptive pain is usually described as aching, sharp or throbbing, and can result from any injury that damages tissues, including cuts, bruises, fractures and burns.

Severe trauma pain may cause the body to act in certain ways to minimize injury, such as increasing blood flow to vital organs. Minor trauma pain is usually the result of common injuries such as scrapes and bruises and does not typically require medical attention.

Acute pain (sudden, short-term pain) and trauma pain often overlap. Sometimes traumatic injuries lead to chronic pain when pain persists longer than expected. Pain can result also from repeated minor trauma over time rather than one sudden injury. Examples of cumulative trauma disorders (repetitive strain injuries) include bursitis, tendinitis and tennis elbow.

Individuals sometimes experience post-traumatic stress disorder (PTSD) after an event involving trauma pain. PTSD is a psychological disorder characterized by continued frightening thoughts stemming from a traumatic ordeal. Typically it affects victims of violent crime or tragic events.

Severe trauma pain requires medical attention. In instances where the patient is unable to communicate with the physician, monitoring of vital signs including blood pressure and heart rate may be necessary. Gathering of a patient’s medical history is also an important component of accurately treating trauma pain. Certain forms of trauma pain may require the use of imaging tests such as MRI or CAT scan.

Treatments vary depending on the type and seriousness of the injury or wound and may range from splinting to surgery. Common over-the-counter analgesics such as aspirin or acetaminophen may resolve pain in mild cases. In more severe incidents, opioids may be prescribed.

Trauma pain can occur from a virtually infinite list of activities or circumstances (e.g., auto accidents, violent crime, sports injuries). Consequently, fail-safe preventative measures in relation to trauma pain do not exist. However, taking certain steps, such as wearing a seat belt while traveling, can minimize one’s risk of enduring trauma and trauma pain.

Trauma pain is pain from an injury or wound caused by external force or violence. It can result from any injury or wound. How one perceives trauma pain depends on many factors. Reactions to pain will differ according to:

• The nature and severity of the injury or wound
• The biological nature of the individual
• Prior experiences and conceptions of pain

Peripheral nerves (those outside the brain and spinal cord) are spread throughout the body. Some peripheral nerves contain nociceptors (nerve endings), which work by sensing different types of pain and drawing attention to the original source of pain. When an individual is injured or wounded, a relay of messages is continually sent and modified by nociceptors through peripheral nerves to the cerebral cortex (the part of the brain involved in thought), where pain is consciously recognized.

Not all nociceptors feel pain in the same way, with some being more sensitive to different types of pain than others. Some nociceptors sense external impact, whereas others may sense changes in temperature or detect pressure. Furthermore, different nociceptors may transmit pain information at varying speeds, depending on the severity or importance of the trauma pain.  

Trauma pain can cause the autonomic nervous system (nerves that regulate subconsciously controlled functions) to respond in ways that encourage healing, including:

• Immobilizing the body to defend against additional injury
  
  
• Raising respiratory and digestion rates
  
  
• Releasing hormones (e.g., adrenalin) to help minimize pain
  
  
• Increasing blood pressure and heart rate to ensure that vital organs receive adequate blood flow

Acute pain (sudden, short-term pain) and trauma pain (pain from injury or wound caused by external force or violence) often overlap. Examples include:

• Scrapes or scratches
• Cuts
• Bruises
• Burns
• Fractures

In some instances, pain associated with trauma can evolve into chronic pain (ongoing or recurrent pain). The likelihood of trauma pain becoming chronic depends on the nature and severity of the initial trauma and the patient’s previous pain experiences, and is often difficult to predict. Common examples of chronic pain resulting from trauma include:

• Recurring head pain, neck pain or back pain stemming from an auto accident
  
  
• Bone, soft tissue or joint pain associated with athletic, workplace or household injuries
  
  
• Persistent headache after a slip or fall
  
  
• Repetitive stress injuries such as bursitis, tendinitis or tennis elbow

• Complex regional pain syndrome stemming from trauma to an arm or leg
  
  
• Gait disturbances due to an injured foot, leg, pelvis or back
  
  
• Fibromyalgia, which in some cases can stem from physical or emotional trauma, according to the American Academy of Pain Management
  
  
• Chronic fatigue syndrome, which sometimes involves physical or emotional trauma, according to the National Women’s Health Resource Center

Post-traumatic stress disorder (PTSD) is a psychological condition that often affects individuals long after the initial trauma pain has ended. PTSD first became well known in war veterans, but it can be caused by any type of physical, emotional or psychological trauma. It is characterized by continued frightening thoughts of the person’s ordeal and can occur in relation to any number of traumatic events or injuries. Victims of violent crime or unforeseen events (e.g., sexual assault, car accidents, natural disasters) tend to be most commonly affected.  

People with PTSD recall details of their trauma regularly and repeatedly. Ordinary events can trigger painful flashbacks of the traumatic incident. Emotional detachment is a common symptom of PTSD. In many cases, anniversaries of the original trauma can be especially painful.

PTSD can affect anyone of any age, though it tends to be more common in adult women. Sleep problems, depression and substance or alcohol abuse are common signs of PTSD.  People with PTSD are usually treated with prescription medications and psychotherapy.

Anything that causes trauma can cause trauma pain.  Millions of Americans experience pain as a result of traumatic injury each year. The effects of injuries can range from simple inconvenience or temporary discomfort to chronic pain , disability and death. Trauma pain (pain from an injury or wound caused by external force or violence) results from a virtually limitless amount of potential causes, including:

• Slips and falls
• Motor vehicle accidents (e.g., whiplash, head injury, spinal cord injury)

• Sports or exercise, such as a rotator cuff injury or torn anterior cruciate ligament
• Household or workplace accidents
• Repetitive strain injuries
• Animal bites
• Firearms
• Child abuse, sexual assault or other violent crime

Trauma can cause pain conditions throughout the body, including:

• Headache, eye pain and ear pain
• Orofacial pain and dental pain
• Neck pain and back pain
• Shoulder pain and elbow, wrist and arm pain
• Chest pain and abdominal pain
• Pelvic pain, sexual pain and scrotal pain
• Leg pain, knee pain, gait disturbances and foot pain
• Other joint pain

The degree to which one experiences trauma pain varies according to the injury or wound sustained and the condition of the patient. Because all people experience a decline in organ function and responsiveness as they age, elders may experience greater difficulty recovering from trauma pain. In some cases involving serious injury, children may also have greater difficulties recovering from trauma pain than healthy adults because their bodies are still developing and certain pain relievers may be unsafe.

Gathering a patient’s medical history (conditions and diseases, prescribed medications, psychological disorders, previous use of opioids and pain background) is important in determining how to best manage trauma pain. Consultations between physician and patient can help minimize the patient’s anxiety and provide insight into how the patient should be treated.

A crucial component in minimizing trauma pain is assessing the pain’s location and intensity. A patient may be unable to articulate information about pain for various reasons (e.g. loss of consciousness or shock). Accordingly, the monitoring of other indicators may be necessary in order to assess trauma pain levels, including:

• Blood pressure
• Heart rate
• Pupil size
• Respiratory rate
• Perspiration

Physicians may use imaging techniques to pinpoint the source of trauma pain, such as:

• X-ray. Produces images of the body using low doses of radiation. Quick, painless and relatively inexpensive, x–rays are a useful tool in diagnosing various forms of trauma pain. They work by passing small amounts of radiation through the body to produce an image on film.
  
  
• MRI (magnetic resonance imaging). A computerized technique that uses magnetic and radio waves to create detailed pictures of soft tissue and the musculoskeletal system. MRI scans pinpoint trauma pain by creating contrasting digital images of normal and abnormal body tissues without side effects to the patient.

• CAT scan (computed axial tomography). Combines x-rays and computer analysis to detail vital structures in the body. This technique is very effective in examining bone and spinal trauma.
  
  
• Bone scan. A type of radionuclide imaging test in which tiny amounts of radioactive materials are used to detect small stress fractures. However, bone scans can be poor in detail and specificity, with results often requiring further testing.
  
  
• Ultrasound. Uses sound waves to create images of internal organs and other body structures. Focused abdominal sonography for trauma (FAST) is often used in emergency rooms to assess low-velocity injuries (e.g., stab wounds) and determine where surgical incisions should be made. Ultrasounds may also be helpful in detecting fetal complications resulting from trauma.
  
  
• Arthrography. Injects a contrast medium to enhance an x-ray of a joint.

Blunt trauma to the chest, abdomen or pelvis can cause a heart attack, and screening tests such as an electrocardiogram (EKG) or blood test of cardiac enzymes can benefit people with these kinds of injuries, according to recent research.

A physician’s care of acute traumatic injury begins with assessing problems with circulation or respiration and restoring or stabilizing normal functions. In many cases, emergency medical technicians have begun this process at the scene of an injury. They may apply cervical collars, spinal bracing, splints or other devices as needed.

Certain pain medications may not be administered to patients for fear of causing further unforeseen complications when life-saving techniques are required. For instance:

• Some analgesics (painkillers) may complicate breathing patterns under certain conditions.
  
  
• Neurological or abdominal exam results can be incorrectly interpreted if the patient is oversedated.
  
  
• Opioids can cause a patient’s condition to worsen in cases of head injury if not carefully administered.
  
  
• Certain medications cannot be mixed if patient is intoxicated with alcohol or any other recreational or illegal drug, which sometimes happens in trauma.

As a result, the challenges associated with treating patients with injuries resulting from acute (sudden, short-term) trauma can often lead to inadequate pain treatment.

Once a patient suffering from acute traumatic injury is stabilized, a more complete care plan can be established and medication for pain control can be administered. Minimizing trauma pain (pain from an injury or wound caused by external force or violence) is an important step to patient recovery. Usually the definitive treatment is the treatment of the underlying problem causing the pain. Successfully isolating and treating trauma pain minimizes discomfort and often results in shorter hospital stays, fewer complications and lower mortality rates.

The amount of treatment needed varies greatly according to the extent of the injury. For example, rest may be recommended for a concussion, though monitoring is essential to ensure that the condition does not worsen. A more extensive head injury or a spinal cord injury may require extensive rehabilitation.

A variety of analgesic and anti-inflammatory medications may be used to help relieve trauma pain, including:

• Intravenous (I.V.) opioids. I.V. opioids are the most popular form of analgesic for treating severe trauma pain. They are administered by inserting a needle into a patient’s vein. A plastic tube called a cannula may be attached to the exterior of the skin to avoid multiple injections. I.V. opioids can be given to patients more consistently as opposed to on demand. I.V. opioids more efficiently reduce pain than other methods as a result.
  
  
• Epidural. Pain medicine administered through an injection in the spinal column. Newer improvements in procedure, equipment and pharmacologic science have made the use of epidural analgesia (pain relief) commonplace for treating certain types of trauma pain (e.g., blunt injury to the chest wall. 
  
  
• Patient-controlled analgesia (PCA). Used in conjunction with I.V. opioids, PCA may be administered and controlled by the patient in certain instances when the patient is sufficiently alert. The patient can receive a predetermined dose of medicine when pain relief is necessary by pressing a button on a computerized pump that is connected to a small tube in the body. Patients cannot take the medicine while sleeping, thus making them less susceptible to respiratory depression and extreme drowsiness.
  
  
• Ibuprofen. Found in many over-the-counter drugs, ibuprofen helps reduce pain and inflammation.
  
  
• Aspirin. This common household drug can be used to reduce pain, fever, inflammation and blood clotting. It works by interfering with the transmission of pain signals to nerve endings.
  
  
• Acetaminophen. This is a drug that reduces pain and fever, but not inflammation.
  
  
• Oral opioids. These are rarely administered to patients incapacitated from traumatic pain. Oral opioids put the patient at high risk for aspiration (inhalation of food or liquid into the lungs) if they are not fully alert or if they have difficulty swallowing as a result of their injury. However, certain types of opioid medications may be prescribed for home use to help alleviate trauma pain when appropriate.
  
  
• Intramuscular (IM) opioids. Introduced to the body by muscular injection, IM opioids are absorbed slowly and tend to relieve pain rather slowly as well. They can also cause discomfort during administration. As a result, these tend to be used infrequently.
  
  
• Subcutaneous (SC) opioids. Similar to intramuscular opioids, subcutaneous opioids are slow in taking effect. Subcutaneous opioids are introduced to the body through the skin by injection, though not necessarily through muscle tissue. This method is not commonly used.

In addition, physicians may prescribe medications to be used at home as needed. The level of dosage and duration of use varies depending on the nature of the trauma pain itself.

Depending on the type of injury, pain management for  acute or chronic trauma may also include:

• Immobilization measures such as splints, casts or traction
  
  
• Therapy such as physical therapy, manipulation therapy or occupational therapy
  
  
• Modalities (physical agents) such as thermotherapy, cryotherapy, hydrotherapy or electrical therapy
  
  
• Injection therapy, such as nerve blocks or epidural corticosteroid shots
  
  
• Operations such as arthroscopy, arthroplasty, spine surgery or carpal tunnel release

• Psychotherapy or support groups, to cope with reactions such as post-traumatic stress

Trauma pain often occurs as the result of unforeseen events, such as slips and falls, automobile accidents or violent crime. Consequently, no preventive measures are foolproof. However, certain actions may decrease the likelihood of trauma and thus prevent trauma pain and life-threatening trauma, including:

• Wearing a helmet when appropriate, such as when riding motorcycles, bikes or skateboards
  
  
• Practicing safe driving habits, including:
  
  
• • Wearing seat belts
  • Using child safety seats
  • Obeying speed limits
  • Keeping proper distance between vehicles
  • Using caution in severe weather
    
    
• Watching for slick or icy patches while walking
  
  
• Not running on stairways, escalators or in crowded areas
  
  
• Practicing proper water safety, including:
  
  
• • Diving in deep water only
  • Not running near swimming pools
    
    
• Wearing appropriate protective athletic equipment for each sport
  
  
• Supervising children, especially while at play or in water
  
  
• Managing anger and stress, which according to recent research increase the risk of traumatic injuries such as falls and fractures

• Controlling aggressive animals
  
  
• Correctly using fireworks, lighters, matches and other substances related to fire
  
  
• Handling and storing firearms properly
  
  
• Avoiding violence (or potentially dangerous situations) whenever possible
  
  
• Practicing good posture and ergonomics to help prevent cumulative trauma disorders such as back strains and possibly carpal tunnel syndrome

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about trauma pain:

1. What activities put me most at risk for trauma pain?
   
   
2. What can I do to protect myself from trauma pain?
   
   
3. How can I minimize trauma pain once it happens?
   
   
4. How can I tell if my trauma pain needs emergency medical attention? 
   
   
5. Where should I go if I suffer from trauma pain?
   
   
6. What medicines will I be taking and why?
   
   
7. How will my medications be administered?
   
   
8. What side effects can I expect from these drugs?
   
   
9. Do you recommend other treatments for me, such as physical therapy?
   
   
10. How long should it take for me to recover from my trauma pain?
    
    
11. Are there ways I can prevent cumulative trauma disorders?