Do Anti-Inflammatory Drugs Cause More Chronic Pain?
By Joseph E. Scherger, MD, MPH
Core Faculty, Eisenhower Health Family Medicine, Residency Program, Eisenhower Health Center, La Quinta, CA; Clinical Professor, Keck School of Medicine, University of Southern California, Los Angeles
SYNOPSIS: Acute inflammation may protect against the development of chronic pain through neutrophil activation. Using nonsteroidal anti-inflammatory drugs may blunt that response and contribute to chronic pain.
SOURCE: Parisien M, Lima LV, Dagostino C, et al. Acute inflammatory response via neutrophil activation protects against the development of chronic pain. Sci Transl Med 2022;14:eabj9954.
Parisien et al studied the transition from acute pain with inflammation to chronic pain and the role nonsteroidal anti-inflammatory drugs (NSAIDs) might play in that process. The authors examined 98 patients with acute low back pain and followed them for three months. Studying the neutrophil response to the inflammation, researchers found neutrophil-driven upregulation of the inflammatory response was protective against the transition to chronic pain. In mice studies from their lab, early treatment with a NSAID blunted the neutrophil response and led to chronic pain.
The authors cited studies from the UK Biobank that identified elevated risk of pain persistence for subjects taking NSAIDs. Investigators postulated the early neutrophil response to acute pain is part of the healing process and is protective against the development of chronic pain. While NSAIDs are helpful in alleviating acute pain, their overall use may be counterproductive for long-term outcomes regarding low back pain.
COMMENTARY
In medicine, we often treat the symptoms of a disease, thinking this is helpful in the recovery process. We treat cough, yet cough is the reflex that helps keep our airways clear. We treat fever, despite the evidence indicating fever is part of the body’s response to infection and contributes to the healing process.1 This study by Parisien et al shows how NSAIDs may blunt the process the body uses to overcome an acute pain process like muscle strain.
I was in medical school in the early 1970s when the first NSAID was approved. It was used widely for pain and inflammation as an alternative to aspirin. During my residency at the University of Washington, naproxen was approved as a longer-acting NSAID. Many other NSAIDs followed, and these are among the most widely used of all medications. Common side effects include GI bleeding, fluid retention, and worse athletic performance.2,3
The work by Parisien et al indicates NSAIDs might interfere with the healing process of acute musculoskeletal pain and contribute to chronic pain. A wise professor in medical school once told me every medication causes its own disease. This stuck with me; over the past 50 years, I have tried to use only essential medications.
REFERENCES
1. Wrotek S, LeGrand EK, Dzialuk A, Alcock J. Let fever do its job: The meaning of fever in the pandemic era. Evol Med Public Health 2020;9:26-35.
2. Vonkeman HE, van de Laar MA. Nonsteroidal anti-inflammatory drugs: Adverse effects and their prevention. Semin Arthritis Rheum 2010;39:294-312.
3. Da Silva E, Pinto RS, Cadore EL, Kruel LF. Nonsteroidal anti-inflammatory drug use and endurance during running in male long distance runners. J Athl Train 2015;50:295-302.
Acute inflammation may protect against the development of chronic pain through neutrophil activation. Using nonsteroidal anti-inflammatory drugs may blunt that response and contribute to chronic pain.
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