New research from researchers at McGill University in Canada suggests that treating some forms of acute pain with anti-inflammatories actually increases the risk of it becoming chronic.
Determine the causes of the transformation of acute pain into a chronic condition
The main objective of this work, recently published in the journal Science Translational Medicine, was to determine the causes of the transformation of acute, punctual pain into a chronic condition. Having focused on the expression of certain genes in a cohort of patients suffering from acute lower back pain, the first step led to the demonstration of a high activity of genes related to the immune system in patients who recovered quickly. their intense back pain.
These same genes were obviously silenced in patients who suffered from long-term chronic pain. In fact, it seemed that people less likely to experience chronic pain had a stronger inflammatory response when in acute pain.
” By analyzing the genes of people with lower back pain, we observed active changes in genes over time in subjects whose pain faded quickly “, Explain Luda Diatchenko, co-author of the study. ” Changes in blood cells and their activity seemed to be the biggest factor, especially in cells called neutrophils. »
If it had been amply demonstrated that the anti-inflammatoriescommonly used by people with back problems, did help reduce pain, these early results suggested that suppressing an early inflammatory response to pain may help increase the risk of developing a chronic form.
Revealing experiments and analyzes
In order to verify this, the researchers carried out a series of experiments on mice, having shown that rodents with back injuries who received conventional nonsteroidal anti-inflammatory drugs were more likely to suffer from long-term persistent pain, even whether the drugs worked effectively as short-term analgesics. Specimens with similar injuries treated with saline or another pain reliever were less likely to show signs of chronic pain.
The researchers were particularly interested in immune cells called neutrophilsand found that directly blocking the activity of these cells in mice resulted in pain responses that lasted 10 times longer than in rodents in the control group.
” Neutrophils dominate early stages of inflammation and set the stage for tissue damage repair “says Jeffrey Mogil, also co-author of the study. ” Inflammation happens for a reason, and it seems dangerous to interfere. »
Third, the team reviewed the medical records of half a million Britons. This survey strikingly revealed that people taking anti-inflammatories for back pain were about 75% more likely to report persistent chronic pain 2-6 years later than those taking paracetamol or antidepressants.
A sensitive study
The study authors are aware that their work is likely to be controversial, given that anti-inflammatories have been widely used for the treatment of acute pain for decades. Mogil explains that his team struggled to get the new study published in a peer-reviewed scientific journal, as peers worried about the radical implications of such findings.
Since steroidal and nonsteroidal anti-inflammatory drugs are valuable treatment options in many cases, the researchers are obviously not advising patients to go completely without them based on this study alone, but to reduce their use when possible. The next step will be to conduct a randomized clinical trial comparing the long-term effects of anti-inflammatories to other analgesics on chronic pain.
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