How can a pain-relieving drug have a long-term negative impact on the body by causing additional pain episodes? New research adds a twist to what we already understood about anti-inflammatory drugs.

Scientists from McGill University and colleagues in Italy say that taking anti-inflammatory drugs and steroids to treat pain could make it more likely that the pain will come back. Their findings call into question long-held pain-relieving techniques. Inflammation is a normal part of the recovery process after a painful injury, and inhibiting it with medicines may result in more difficult-to-treat pain.

“For many decades it’s been standard medical practice to treat pain with anti-inflammatory drugs,” says Jeffrey Mogil. But they “found that this short-term fix could lead to longer-term problems.”

The researchers looked at pain processes in both humans and animals in a study published in Science Translational Medicine. They discovered that neutrophils, a type of white blood cell that aids the body in fighting infection, play an important role in pain relief.

While “analyzing the genes of people suffering from lower back pain,” they “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,” adds Luda Diatchenko.

Inflammation is a dominant factor in the mechanism of pain

According to professor Mogil, “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.”

In mice, inhibiting neutrophils in the lab increased the duration of discomfort by ten times. Anti-inflammatory medicines and steroids like dexamethasone and diclofenac had the same effect, despite the fact that they were helpful against pain at first.

A separate study of 500,000 people in the United Kingdom found that those who took anti-inflammatory medicines to alleviate their pain were more likely to have pain two to ten years later, an impact not evident in those who took acetaminophen or antidepressants.

Standard medical treatment for acute pain is under review

The findings of the study “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,” adds Massimo Allegri.

They found “that pain resolution is actually an active biological process,” adds Professor Diatchenko.

The authors say “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.”

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