Findings may lead to reconsideration of how we treat acute pain:
Using anti-inflammatory drugs and steroids to relieve pain could increase the chances of developing chronic pain, according to researchers from McGill University and colleagues in Italy. Their research puts into question conventional practices used to alleviate pain. Normal recovery from a painful injury involves inflammation and blocking that inflammation with drugs could lead to harder-to-treat pain.
[...] "In analyzing the genes of people suffering from lower back pain, we observed active changes in genes over time in people whose pain went away. Changes in the blood cells and their activity seemed to be the most important factor, especially in cells called neutrophils," says Luda Diatchenko a Professor in the Faculty of Medicine, Faculty of Dentistry, and Canada Excellence Research Chair in Human Pain Genetics.
"Neutrophils dominate the early stages of inflammation and set the stage for repair of tissue damage. Inflammation occurs for a reason, and it looks like it's dangerous to interfere with it," says Professor Mogil, who is also a member of the Alan Edwards Centre for Research on Pain along with Professor Diatchenko.
[...] "Our findings suggest it may be time to reconsider the way we treat acute pain. Luckily pain can be killed in other ways that don't involve interfering with inflammation," says Massimo Allegri, a Physician at the Policlinico of Monza Hospital in Italy and Ensemble Hospitalier de la Cote in Switzerland.
[...] "We discovered that pain resolution is actually an active biological process," says Professor Diatchenko. These findings should be followed up by clinical trials directly comparing anti-inflammatory drugs to other pain killers that relieve aches and pains but don't disrupt inflammation."
Journal Reference:
Marc Parisien et al., Acute inflammatory response via neutrophil activation protects against the development of chronic pain [open], Sci. Trans. Med., 14, 644, 2022
DOI: 10.1126/scitranslmed.abj9954
(Score: 2) by Freeman on Monday May 16 2022, @06:11PM (2 children)
Probably #1 Drug I've had in my life is an "anti inflammatory". Now, if it's only an issue with ones that are meant to be pain relievers, I might not be so bad off.
Joshua 1:9 "Be strong and of a good courage; be not afraid, neither be thou dismayed: for the Lord thy God is with thee"
(Score: 5, Interesting) by Gaaark on Monday May 16 2022, @08:30PM (1 child)
My wife used to have massive leg pains so she couldn't sleep unless she took massive pain relievers: a doctor told her to try heavy doses of vitamin D (she usually goes with 6x1000iu D3, then reduces it to 4 or 5 a day).
She can now sleep.
--- Please remind me if I haven't been civil to you: I'm channeling MDC. ---Gaaark 2.0 ---
(Score: 0) by Anonymous Coward on Wednesday May 18 2022, @09:52PM
When i was a growing teen and had leg pains that stopped me from sleeping, my mother would also give me vitamin D pills(along with calcium). I don't know if it was the placebo effect, but it did seem to reduce the severity and length of the pain.
(Score: 4, Insightful) by DannyB on Monday May 16 2022, @07:40PM (2 children)
I think I am a counter example to TFA. I have taken prescription anti inflammatory drugs all day, every day for arthritis since 2005. If I happen to miss a dose, I definitely notice it within about an hour or so of missing it. So I would say they are still effective.
Even with that, I sometimes also take prescription narcotic pain killers since 2009. Last year I asked for and was given a 50% increase in frequency I could take narcotics, but I asked to stay on same pill dose. I think this means nothing more than there are some days where the anti inflammatory drugs are just not enough.
If I have any kind of procedure where I may have bleeding (colonoscopy, endoscopy, etc) I have to stop taking anti inflammatory drugs for several days before and after procedure. I am given lots of extra narcotics to take all day and night on those days. I can say I would MUCH prefer to be on the anti inflammatory drugs than the narcotics. The narcotics are great stuff -- but they (mostly) mask the pain rather than prevent it.
How often should I have my memory checked? I used to know but...
(Score: 3, Interesting) by Bethany.Saint on Tuesday May 17 2022, @02:14PM (1 child)
That's sort of what the backing (science.org) article is saying. Taking anti-inflammatory (NSAIDs) drugs makes you have chronic pain when you stop taking them. The article says that by not allowing the inflammation response your body doesn't get the right "signal" to send out the chemicals needed to repair the underlying damage. So you get trapped in the cycle of stopping the NSAIDs causes more pain (because the body needs the pain signals), you take the NSAIDs again and the pain goes away not because you're healing but because of the drugs.
Definitely don't change your drugs because of this article but what you're describing is what the study says happens. Your example is more of a proof than counterexample.
(Score: 3, Interesting) by DannyB on Tuesday May 17 2022, @04:40PM
I had years of worsening chronic pain before starting prescription anti inflammatory drugs. Before prescriptions, I was taking OTC anti inflammatory drugs. Before that I was just having lots of aches and pains all the time. These gradually worsened. Before taking drugs, nothing was making this get any better "naturally". The underlying damage is caused by arthritis and gets progressively worse over the years. That is the natural outcome of the disease. The ever worsening pain is part of the package.
How often should I have my memory checked? I used to know but...
(Score: 0) by Anonymous Coward on Monday May 16 2022, @08:14PM (1 child)
attempts to reproduce the study results.
This seems to be like awful news for the people with the worst pain. Every pill or injection they take to reduce their pain today increases the chances it exists and is worse tomorrow. That's a horrific downward spiral to get caught on.
I rarely use any kind of painkiller, but my pain tolerance is absurdly low. I'm just lucky enough to rarely experience significant pain.
(Score: 1, Insightful) by Anonymous Coward on Monday May 16 2022, @08:19PM
(same AC) However, I'm more interested in their study with mice than with their analysis of 500k UK patient medical records. The rodent study can be cut and dried, rodent A has more or fewer neutrophils for the same injury than rodent B. For people, if patient A has chronic ibuprofen use and patient B does not, maybe patient A experienced more pain from the initial injury and more ongoing pain after. That is, maybe the heavier use of pain medications is the result of more pain and not the cause. Unless they're dissecting everyone studied, I imagine it's impractical to know.
(Score: 2) by inertnet on Monday May 16 2022, @11:22PM
It's only logical that suppressing pain may have consequences.
(Score: 0) by Anonymous Coward on Monday May 16 2022, @11:47PM
This is why I hold off on the pain meds as long as possible. For a headache I'll try non-drug methods first such as shower, alternating heat/cold compress, relaxation, etc. If it looks like it just won't stop, then out comes the ibuprofen at the recommended dose.
I'm not a masochist or a prude, I just know that drugs have side effects and I think it's a good idea to minimize their use if you can. I don't really have science to back it up though. I'd love to know if delaying the meds is actually worth it.
OTOH, I have little doubt that I did the right thing with Vicodin. I was prescribed it once for a strained back. When the back pain went away, I had a few left. I'd pull them out when I had a really bad headache. It made ibuprofen seem like tic-tacs and when they ran out I faced that choice that we all face: seek more or not.
I've heard enough "that's how it started" stories to know better. The first few ibuprofen only headaches sucked, but I got over it. I haven't had any Vicodin since then, and that was 15 years ago.
(Score: 5, Informative) by Azuma Hazuki on Tuesday May 17 2022, @02:50AM (5 children)
Most of the drugs in question here are NSAIDs with specifically anti-inflammatory properties -- your ibuprofen and naproxen, yes, and also the Rx-only heavier hitters like meloxicam, indomethacin, celecoxib, etc.
These work by blocking the activity of cyclooxogenase enzymes 1 and 2 (the *coxib family being very specific for COX-2, which brings its own problems...remember Vioxx, rofecoxib?). They tend to be reversible, unlike aspirin, whose inhibition of COX-1 specifically is what lends it its different properties compared to the other NSAIDs. Tylenol (acetaminophen or paracetamol) is different even further in that it works centrally, not systemically, and has very little anti-inflammatory action itself.
The COX enzymes are mostly known for their role in producing inflammatory messenger chemicals, the prostaglandins. Interestingly, aspirin's permanent suppression of COX-1 changes the output, leading to more anti-inflammatory prostacyclins and fewer pro-inflammatory prostaglandins. This is a very simplified explanation but it's the meat of how NSAIDs damp down inflammation.
Inflammation, though, serves a purpose. Fever is part of the inflammatory response, for example, and constantly knocking a fever down with NSAIDs might actually make the body take longer to kill off a viral or bacterial infection. There's also the possibility that constantly suppressing the inflammatory response conditions the body to "inflame harder" as it were. And all the NSAIDs except aspirin and *possibly* naproxen (due to the latter's take-no-prisoners effect on thromboxane) are now known to increase clot and CV accident risk. Some of the observed chronic pain referenced in the article may be due to the knock-on effects of long-term NSAID therapy causing chronic low-level damage to the vasculature...
I am "that girl" your mother warned you about...
(Score: 0) by Anonymous Coward on Tuesday May 17 2022, @12:35PM (4 children)
What non-anti-inflammatory OTC painkiller options are there if I want to have something on hand?
(Score: 3, Informative) by Azuma Hazuki on Tuesday May 17 2022, @03:39PM (2 children)
There isn't much out there OTC aside from Tylenol or aspirin honestly.
Lidocaine topical formulations (patches, gels, etc) are available in strengths up to 4% over the counter, though there are dosage/exposure limits to that too. Lidocaine works by blocking the transmission of nerve signals due to sodium channel blockade, if I remember right. Heating or cooling compresses may be useful depending on the nature of the injury or pain. Someone upthread mentioned their wife is sleeping better after vitamin D3 supplementation, so a small but global general reduction in pain may result from keeping a good diet.
Pain really isn't very well understood, partly because there's a perverted Calvinistic streak in this country that almost worships suffering as either penance, just deserts, or both.
I am "that girl" your mother warned you about...
(Score: 0) by Anonymous Coward on Tuesday May 17 2022, @04:57PM
Thank you.
(Score: 0) by Anonymous Coward on Saturday May 21 2022, @02:14AM
Then why don't other countries understand it?
(Score: 2) by sjames on Wednesday May 18 2022, @12:10AM
A bottle of whiskey and a bullet to bite on.
(Score: 0) by Anonymous Coward on Tuesday May 17 2022, @06:50AM
After the one on fungal infections, I just hope that MartyB is alright.