Blocking inflammation can lead to chronic pain

A provocative new study suggests that using anti-inflammatory drugs and steroids to treat an injury, such as a sprained ankle or torn back, increases your risk of chronic pain.

The short version: When taking painkillers like ibuprofen, which reduce inflammation, we disrupt the normal biological repair process associated with inflammation.

The end result – the pain is harder to treat in the long run.

“Treating pain with anti-inflammatory drugs has been the standard medical practice for decades. But we found that this short-term solution can lead to longer-term problems,” said Professor Jeffrey Mogil, a neuroscientist at McGill University in Quebec and senior author of the study.

The implications are far-reaching; if the research results hold up in a gold-standard clinical trial, the accepted way we treat pain from injury will be turned upside down.

How was this discovery made?

Blocking inflammation can lead to chronic pain

First, the researchers from Canada and Italy analyzed the activity of genes and blood cells in 98 patients with acute low back pain over three months.

The idea was to better understand the mechanics of pain and, in these patients, see if and how their pain was resolved.

In some patients, the pain did indeed go away. Why?

The key to resolving their pain was neutrophils — white blood cells fighting infection.

Professor Mogil said neutrophils “dominate the early stages of inflammation and pave the way for tissue damage repair”.

He said inflammation “occurs for a reason, and it looks like it’s dangerous to interfere with it.”

How the findings were confirmed

Mice were subjected to a temporary injury to the sciatic nerve that would normally heal naturally.

By experimentally blocking neutrophils in these mice, the pain was prolonged to 10 times the normal duration.

Treating the pain with anti-inflammatory drugs and steroids such as dexamethasone caused the same prolongation after it was initially effective against pain.

These findings are supported by an analysis of 500,000 people in the UK that found that those taking anti-inflammatory drugs to treat their pain “had more pain two to 10 years later,” an effect not seen in people taking acetaminophen or – depressants.

The researchers advise that it has not been made clear that the anti-inflammatory drugs used in the UK have not been identified, but they have assumed that it was the commonly used ibuprofen.

Where to from here?

“Our findings suggest it may be time to rethink how we treat acute pain. Fortunately, pain can be killed in other ways without interfering with inflammation,” said Dr. Massimo Allegri, a physician at Policlinico di Monza Hospital. in Italy and co-author of the study.

The study has been widely reported, including a lengthy analysis in The New York Times, asking for comments from physicians not involved in the study.

Dr. Bruce M Vrooman, a pain specialist at Dartmouth Hitchcock Medical Center in New Hampshire, said the study was “impressive in its scope.”

He agreed that if the results hold up in a clinical trial, it “could force a rethink of how we treat acute pain.”

Dr. Thomas Buchheit, director of the regenerative pain therapy program at Duke University, described the findings as “definitely a paradigm shift.”

He said, “There’s an unspoken rule: if it hurts, take an anti-inflammatory, and if it still hurts, put a steroid on it.”

The study suggests that “we need to think about healing, not suppressing inflammation.”

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