Do Anti-Inflammatories Lead To Chronic Pain?

A very common treatment for pain and injury is non-steroidal anti-inflammatories (NSAID's), such as Ibuprofen, Naproxen and Diclofenac. These drugs are often prescribed as the first course of action by doctors.

But could these drugs actually make you more likely to develop chronic pain?

A 2022 study looked at the role of the immune system in the transition from acute to chronic lower back and jaw pain, and the use of anti-inflammatory medication. 

The results were startling:

• The normal acute inflammatory response to an injury is healthy and plays a vital role in resolving acute pain
• Chronic pain involves the neuroimmune system
• NSAID use is associated with a higher risk of developing chronic pain

Do these results surprise you?

A 2022 study looked at the transition of pain from acute to chronic and the role of the immune system. If we understand the pathophysiological  mechanisms that prolong the pain response we can find a way to stop chronic pain developing. 

There were 4x study groups:

1. Low back pain - 98 patients with acute lower back pain (49 with resolved pain and 49 with persistent pain) were examined at enrolment and 3 months later
2. Temporomandibular disorder (TMD) - a repeat of group 1 with patients experiencing jaw pain. There was also a control group.
3. Mouse study 
4. UK Biobank clinical data on analgesic use and back pain 

Results

1) Low Back Pain

Genetic markers for immune cells (neutrophils) were examined. At the first visit there were no significant differences between the group with resolved pain and those experiencing persistent pain.

After 3 months neutrophil activation-dependent inflammatory genes were up-regulated in the resolved pain group, whereas no changes were observed in the persistent group.

Neutrophils are a white blood cell that form part of the innate immune system - the body's first line of defence against infection or tissue damage. 

When you hurt yourself, that initial heat, swelling and pain is the acute inflammatory response, with neutrophils leading the body's defences.

The results of study group 1 suggest that temporarily up-regulating neutrophil-driven inflammatory pathways protects against the development of chronic pain.

2) TMD (Jaw Pain)

The results from study group 2 mirrored those in group 1 for low back pain, with the addition of a healthy control group for comparison.

The recovered group has a higher inflammatory response at the initial acute stage compared to the persistent pain group.

At the follow up, both of the TMD study groups has a lower inflammatory response compared to the healthy control group.

3) Mouse Study

In mouse pain assays, early treatment with a NSAID reduced pain in the short-term, but then ended up prolonging the pain response. Treatment with other types of painkillers (analgesics) did NOT lead to a persistent pain response.

Depleting neutrophils delayed the resolution of pain in the mice, and injecting neutrophils prevented the development of long-lasting pain.

4) UK Biobank clinical data on analgesic use and back pain

Analysing the pain history of patients reporting acute back pain in the UK Biobank identified a higher risk of persistent pain in those who took NSAIDs.

In addition, the higher the neutrophil load the lower the risk of developing chronic pain.

Takeaways

The 2 main takeaways from this research are:

• All 4 studies showed 1 consistent result - a healthy inflammatory response in resolving acute pain, and protects against chronic pain.
• Early administration of NSAIDs relieves pain in the short-term, but increases the risk of pain becoming a long-term issue.

How Can You Use This Study To Help You Recover From Injury Successfully?

• Try to limit the use of NSAIDs in the early stages of an injury
• Explore other methods of pain relief eg. paracetamol / compression / support / heat / ice / gentle movement
• Reframe the initial soreness and swelling of an injury as a normal, healthy response by the body to manage an acute problem.

It's very tempting to use NSAIDs to mask the initial painful symptoms of an injury, especially if you're training for a competition or don't want to stop exercising. 

This study shows that approach could be detrimental to your long-term health. 

I believe there's always nuance, rather than a set black and white approach.

There's growing evidence that NSAIDs can increase inflammation and damage the gut wall lining if taken regularly. However, they're also effective at helping to reduce pain.

It's well documented that appropriate movement is important in recovering from injury and regaining full function of your body.

If NSAIDs help you to move your body, try to use the minimum effective dosage and stop taking them as soon as you can to preserve your long-term health.

Link to the study below.

NEXT STEPS

1) Make this the year you find freedom from persistent or recurring pain and muscle tension with The Befriend Your Body (BYB) Method pain relief workshop retreat.

Read about the upcoming workshop retreat and the results class members have gained from The BYB Method, some of them life changing, in their own words HERE.

8.5 hours of live tuition including 2x deeply relaxing sound bath experiences, with an optional 30 days of 1:1 personal coaching support to help fast track your results.

We'll bust some of the most common industry myths that are keeping you stuck in pain, and what to do instead to get out of pain. 

Read all the details about this event HERE.

2) You can also:

• Book into a Stretch, Yoga or Pilates class with me - these are a good introduction to The BYB Method and to take the first steps to your pain-free body.
• Attend a mind-body retreat - these are deeply relaxing, fun, social small group experiences typically held in various locations within easy reach of Worthing, West Sussex. The next retreat is  on Sunday 24th March. Click HERE for all the details.
• Subscribe HERE to receive "The Movement Chronicle", a weekly e-newsletter delivering mobility and pain reduction tips directly into your inbox every Monday morning,

If you would like support with managing pain or an injury please reach out to me on any of these channels:

• Email at norma@unicornhealthandfitness.com
• DM me on Facebook Messenger 
• WhatsApp message to 07801 867361.

Study Link

• Marc Parisien et al.

 ,Acute inflammatory response via neutrophil activation protects against the development of chronic pain.Sci. Transl. Med.14,eabj9954(2022).DOI:10.1126/scitranslmed.abj9954