Using medications such as ibuprofen and steroids for short-term pain relief may increase the risk of developing chronic pain, new research suggests.
The results of the small study challenge conventional methods of treating pain and indicate that it may be time to reconsider how pain is treated.
Normal recovery from a painful injury involves inflammation – the body’s natural response to injury and infection – and new research indicates that blocking inflammation with medication could lead to pain that is more difficult to treat.
It may be that inflammation has a protective effect and that reducing it too much can be harmful.
In other words, inflammation can prevent acute pain from turning into chronic pain.
Jeffrey Mogil, professor of pain studies at McGill University in Canada, said: “Although ibuprofen has not been studied explicitly in human or mouse data [in the mouse we used diclofenac]as ibuprofen is so common in the UK, it is highly likely that a large percentage of those in the UK biobank who reported taking ‘NSAIDs’ [non-steroidal anti-inflammatory drugs] were actually taking ibuprofen.
Researchers said lower back pain was the most commonly reported form of chronic pain – pain that persists longer than expected after injury – and results in massive economic and medical costs each year.
Most patients receive standard treatments such as nonsteroidal anti-inflammatory drugs such as ibuprofen and corticosteroids.
But these drugs are only marginally effective, and little is known about why acute pain – which begins suddenly in response to something specific, such as an injury – resolves in some patients but persists as chronic pain. in others.
To understand the transition from acute to chronic low back pain, researchers followed 98 patients with acute low back pain for three months.
They also looked at pain mechanisms in humans and mice and found that neutrophils – a type of white blood cell that helps the body fight infection – play a key role in pain resolution.
Blocking these cells in mice prolonged pain up to 10 times the normal duration.
Treating the pain with anti-inflammatories and steroids such as dexamethasone and diclofenac also produced the same result, although they were effective for the pain early on.
The researchers said the findings were backed up by a separate analysis of 500,000 people in the UK Biobank study which showed those who took anti-inflammatories to treat their pain were more likely to have pain for two to 10 years. later.
This effect has not been seen in people taking paracetamol or antidepressants.
Dr Franziska Denk, a senior lecturer at King’s College London, said: “It would certainly be premature to make recommendations about people’s medications until we have the results of a prospectively designed clinical trial. “
Professor Blair Smith, from the University of Dundee, said: ‘The theory is that inflammation can have a long-term protective effect and that reducing inflammation too much can be harmful.
“However, it is important to note that this is only one study and further research is needed to confirm and investigate this issue further.
“It is also important to note that anti-inflammatory drugs are effective in short-term pain management.
“There is good quality evidence to support this and it should not be withheld unnecessarily.
“Anti-inflammatories have a number of other potentially dangerous side effects, and their long-term use is generally discouraged except with caution.”
The results are published in Science Translational Medicine. – Sound system
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