Yes. Anti-inflammatory drugs used to block pain, including for chronic pain treatment, also slow down neutrophils, a type of white blood cell. Studies show that raises the risk of chronic pain. Inflammation is a defense that helps you heal. So experts urge a new approach to treating joint inflammation.
Inflammation is a defense the body needs to rebuild tissue. But inflammation that runs out of control can do more harm than good. It causes redness and, more important, severe pain. So doctors are quick to prescribe anti-inflammatory drugs for chronic pain. They forget that pain is also a sign that repair is underway. That is why drugs like non-steroidal anti-inflammatory drugs (NSAIDs) are among the most used drugs.
More and more people now live with chronic pain. So researchers want to know why some people are more likely to get it. One reason may be treating joint inflammation too hard.
This does not mean you should never treat inflammation. You should treat only inflammation that is out of control. Heavy drugging of inflammation should be avoided. It also blocks healing, and that makes the problem chronic.
These findings call some common ways of treating pain into question. Doctors and patients should be careful when treating chronic pain and joint inflammation. Not all painkillers block inflammation. Opioids and acetaminophen do not. But drugs like ibuprofen and diclofenac do block inflammation, and they can make the problem chronic.
The new study was published in Science Translational Medicine. Researchers looked at how pain works in both mice and humans. They found that white blood cells called neutrophils play a key role in fighting infection, rebuilding tissue and healing.
The study found that people with chronic pain had certain gene changes. Those changes altered how their white blood cells worked, and they seem to alter how their neutrophils work. That put these people at higher risk of chronic pain.
Here is the key point. Neutrophils run the early stage of inflammation. They set the stage for tissue repair. If heavy anti-inflammatory drugs disturb that early stage, the problem is more likely to become chronic.
In the study, when researchers blocked neutrophils in mice, the pain lasted up to ten times longer. Treating pain and inflammation with dexamethasone or diclofenac did the same. Both drugs worked well to block pain early on. But in the end, they raised the risk of chronic pain1.
This is not the first study to find this. An earlier study looked at half a million people in the UK. People who took anti-inflammatory drugs more often, and treated inflammation hard, were more likely to have pain two to ten years later. People who chose acetaminophen or antidepressants did not show this effect.
This study matters, because NSAIDs are often the first choice for many painful, inflamed conditions. Some NSAIDs are even sold over the counter. So doctors must rethink how they treat pain. And patients must know the risks of heavy anti-inflammatory treatment.
Of course, such treatments feel good in their early stages as they provide quick relief. But as the studies show, such a treatment approach may considerably increase the risk of chronic pain.
It is vital to understand that blocking every kind of inflammation is a bad idea. After all, it is part of healing. Put up with some pain. Let the body heal itself, and wait for the pain to fade. If the pain is severe, it is better to use drugs that dull pain but leave inflammation alone.
Frequently asked questions
Can anti-inflammatories cause more pain?
They can make pain last longer. Neutrophils, a type of white blood cell, lead the early stage of inflammation and set up tissue repair. When researchers blocked neutrophils in mice, pain lasted up to ten times longer. Dexamethasone and diclofenac eased pain early but raised the risk that it became chronic. A UK study of half a million people found the same pattern two to ten years later.
Is inflammation good for healing?
Yes. Inflammation is a defense the body needs to rebuild tissue. It causes redness and pain, but that pain is also a sign that repair is underway. Neutrophils run the first stage and prepare the ground for healing. Shut that stage down hard, and repair is disturbed. That makes it more likely the problem becomes chronic.
Which pain relievers do not suppress inflammation?
Opioids and acetaminophen ease pain without blocking inflammation. Drugs such as ibuprofen and diclofenac do block it, and so does the steroid dexamethasone. In the UK study, people who chose acetaminophen or antidepressants did not show the higher risk of later pain seen in heavy anti-inflammatory users. When pain is severe, a drug that dulls pain but leaves inflammation alone is the better choice.
Should inflammation be left completely untreated?
No. The problem is heavy suppression, not treatment. Inflammation that runs out of control can do more harm than good and still needs care. What you should avoid is shutting down every bit of inflammation, because that also shuts down healing. The better approach is to put up with some pain, let the body repair itself, and wait for the pain to fade.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
