Anti-inflammatory Drugs May Lead to Chronic Pain
- A new study found that short-term use of anti-inflammatory medications may contribute to chronic pain.
- In the United States, there are about 50 million adults with chronic pain, with injury being a common cause.
- Research has shown that while anti-inflammatory medications like NSAIDs may resolve pain in the short term, they can also lead to long-term pain for some people.
Using anti-inflammatory medications like steroids or ibuprofen may relieve pain in the short-term setting, but a new study suggests this may lead to chronic pain.
Research published in the journal Science Translational Medicine led by clinicians at McGill University in Canada suggests that it may be time to re-examine how pain is treated in the short term and how that translates to long-term pain.
There are about 50 million adults with chronic pain in the United States. According to the Centers for Disease Control and Prevention (CDC), injury is the most common cause of chronic pain, and 25% of U.S. adults report having lower back pain in the last three months.
Inflammation is a natural response
After an injury, inflammation starts to increase throughout the body. This is the body’s natural response to infection or injury, and as inflammation increases, the person may feel pain in stronger amounts. However, blocking these natural inflammation pathways may result in possible long-term and chronic consequences.
Jeffrey Mogil, PhD, an author of the study and the Canada Research Chair in Genetics of Pain at McGill University, tells Healthline that the inflammation is intentional and necessary.
“It’s possible that that inflammation that the body naturally makes might be there for a reason,” Dr. Mogil explained.
“There is already evidence that if you block the body’s inflammation that it disrupts wound healing, so it’s possible that you shouldn’t be blocking something that the body is trying to do for a reason,” he said.
Research findings
The researchers examined patients and mice with lower back pain for three months on a physical and cellular level.
Many people who experience pain take anti-inflammatory medications like nonsteroidal anti-inflammatory drugs (NSAIDs) or steroids to help resolve their pain. However, while some people will fully resolve their pain, others will translate this into chronic pain.
The researchers examined 98 patients over three months and found that a particular cell in the body called neutrophils was a key player in the pain response pathway.
They discovered that while blocking these neutrophils may help reduce pain in the short term, in mice, blocking them can prolong the pain for up to 10 times longer. Similarly, patients who had elevated levels of neutrophils — those without having these cells reduced by medications — had protective findings against translating acute into chronic pain.
The researchers also said that other studies had supported their findings as well. An analysis in the United Kingdom that included about 500,000 individuals found that people who took anti-inflammatory medications experienced long-term chronic pain for the next two to 10 years.
“There are multiple studies of evidence that are pointing in the same direction, each of them compensating for the flaws of the other, and this is all part of a bigger story in understanding chronic pain,” Mogil told Healthline.
“In patients with chronic back pain, the association between NSAID use and the persistence of pain is a little more than suggestive, but it is significant and means that it is worth our time to better controlled studies to see if this is truly the case,” said David Edwards, MD, PhD, Chief of the Division of Pain Medicine and Associate Professor of Anesthesiology & Neurological Surgery at Vanderbilt University Medical Center in Nashville, Tennessee.
Guidelines from the American Academy of Family Physicians suggest that instead of initially turning to medications to treat pain, using heat, massages, or physical therapy should be the first step. If those don’t work, medications like anti-inflammatories or other analgesics like acetaminophen can assist.
Dr. Edwards suggests that you should ask your doctor two important questions before starting any pain medications, even common ones like NSAIDs or acetaminophen. “What are the side effects of this medication if I use too much? And how long is it safe to use this medication, and when should I stop?”
More research needed
Scientists continue to investigate and answer questions about pain both at acute and chronic levels. Pain affects almost everyone and understanding how it works and how to treat it is important.
While this data is compelling, both Edwards and Mogil agree that more randomized and controlled studies need to be performed before there is a complete shift in how to treat pain.
“This research points us in the right direction and makes us reconsider how we treat pain, and the next step is to test this in a prospective way, in the clinic,” Edwards told Healthline.
Mogil tells Healthline that while his teams are already discussing and evaluating how they’re going to investigate this further, he believes that others will use this evidence to further understand the pain process in other areas.
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