Dr. Timothy Mazzola
NSAIDs and Steroids Associated with Increased Risk of Chronic Pain
A new study by McGill University and colleagues in Italy shows that taking an NSAID (non-steroidal anti-inflammatory drug) or steroids to treat acute pain or injury can actually lead to chronic pain down the line. Common NSAIDS like ibuprofen (Advil), aspirin, and naproxyn (Aleve) are taken by millions daily to treat their pain, but it looks like this may be causing side effects long-term. When the body sustains injury, inflammation is a natural part of the healing process. The body will send in neutrophils as part of the inflammation process, and neutrophils prepare for tissue repair. NSAIDs block the neutrophils and mice and humans who were given them in these studies were found to have increased long-term duration of pain: up to 10 times as long in the studies with mice and 2 to 10 years following treatment in humans. See the study listed below with its abstract and a link to the full study.
Acute inflammatory response via neutrophil activation protects against the development of chronic pain MARC PARISIEN, LUCAS V. LIMA, CONCETTA DAGOSTINO, NEHME EL-HACHEM, GILLIAN L. DRURY, AUDREY V. GRANT, JONATHAN HUISING, VIVEK VERMA, CAROLINA B. MELOTO, LUDA DIATCHENKO +11 authors
SCIENCE TRANSLATIONAL MEDICINE 11 May 2022 Vol 14, Issue 644 DOI: 10.1126/scitranslmed.abj9954
Review of the Article here:
Chronic pain can develop from an acute pain state. The mechanisms mediating the transition from acute to chronic pain remain to be elucidated. Here, Parisien et al. focused on the immune system using samples from patients and animal models. Transcriptomic analysis in immune cells from subjects with low back pain showed that neutrophil activation–dependent inflammatory genes were up-regulated in subjects with resolved pain, whereas no changes were observed in patients with persistent pain. In rodents, anti-inflammatory treatments prolonged pain duration and the effect was abolished by neutrophil administration. Last, clinical data showed that the use of anti-inflammatory drugs was associated with increased risk of persistent pain, suggesting that anti-inflammatory treatments might have negative effects on pain duration.
Blocking neutrophils in mice increased pain duration by up to tenfold. Anti-inflammatory medicines and steroids such as dexamethasone and diclofenac had the same effect, despite being helpful against pain early on.
These results are also corroborated by a separate study of 500,000 individuals in the United Kingdom, which found that those who used anti-inflammatory medicines to alleviate their pain were more likely to have pain two to ten years later, an effect not observed in people who took acetaminophen or anti-depressants.
Download the full study by clicking on the red download button just below "This PDF file includes Materials and Methods" at the bottom of this link: https://www.science.org/doi/10.1126/scitranslmed.abj9954