Over twenty five years ago, I wrote in my book the Collagen Revolution, that the body’s natural healing response is inflammation. If you stopped inflammation. You stopped healing. Therefore you needed inflammation to heal but you needed inflammation to be controlled so that excessive swelling and chronic inflammation did not in of itself cause joint degeneration.
Inflammation is the trigger for the cascade of events that follow in wound and injury repair. In my opinion, the moment inflammation became the enemy of healing, is the moment chronic pain started becoming a billion-dollar business for drug companies. When Ibuprofen was introduced in 1974, it was heralded as one of the great steps in the management of pain. By 1976, two years after its introduction, 1.7 billion tablets had been produced. Today, millions of prescriptions for pain relievers are written annually and tons of aspirin are consumed each day. Yet chronic pain persists. Why? Because these drugs only mask the problem of pain and do not attempt to cure it.
Furthermore, these drugs come with their own risks of addiction and unpleasant side effects. If you suffer from myofascial pain, joint pain, arthritis, sprained or strained ligaments, almost any kind of pain, most likely your doctor will prescribe one of the non-steroidal anti-inflammatory drugs, or NSAIDs. These drugs will reduce the inflammation, which in the short-term reduces the pain. However, in the long-term they set you up for more pain and long-term chronic injury and worse.
Why You May Win the Pain Battle, BUT Lose the Pain War
Understandably, people do not like to feel pain and would like to prevent it at all costs. People want immediate relief and getting rid of the inflammation often provides that relief. Further, with surgeries delayed, anti-inflammatories were seen as necessary if not essential to patient well-being. What was the cost of that temporary well-being? The basic truth is that immediate relief does not equal long-lasting relief. Interfering with the body’s healing process by stopping inflammation to reduce pain causes long-term suffering down the road. Inflammation does cause pain, but, pain can be your friend. It is the body’s siren alerting you that you have injured yourself. Getting rid of inflammation with NSAIDs provides some immediate relief from pain. It sets you up to win the battle, but lose the war.
By stopping inflammation we shut down the body’s natural healing which inhibits the growth of new tissue. In our practice, many alarmed patients have had to stop the use of NSAIDs because of stomach discomfort, nausea, and dizziness.
Inflammation, and the accompanying pain, are actually your allies in healing.
In my book of more than 20 years ago I went on to explain: Unfortunately, this is where chronic problems begin, because the conventional medical practice with its emphasis on pain relief, treats the symptom—pain, and not the problem—joint and spine instability brought on by ligament weakness. A patient will likely be told to take anti-inflammatory drugs, which is often precisely the wrong thing to do because inflammation is the first part in the body’s healing process. Nonsteroidal anti-inflammatories NSAIDS and cortisone (an anti-inflammatory steroid) can give immediate relief, but with a risk of creating a long-term injury with chronic pain. By blocking inflammation, anti-inflammatories never allow complete healing, and instead, aggravate the situation.
Twenty years later “Using anti-inflammatory drugs and steroids to relieve pain could increase the chances of developing chronic pain”
Now, let’s read from a press release issued in May 2022 from McGill University in Canada.
“Using anti-inflammatory drugs and steroids to relieve pain could increase the chances of developing chronic pain, according to researchers from McGill University and colleagues in Italy. Their research puts into question conventional practices used to alleviate pain. Normal recovery from a painful injury involves inflammation and blocking that inflammation with drugs could lead to harder-to-treat pain.
“For many decades it’s been standard medical practice to treat pain with anti-inflammatory drugs. But we found that this short-term fix could lead to longer-term problems,” says Jeffrey Mogil, a Professor in the Department of Psychology at McGill University and E. P. Taylor Chair in Pain Studies.
In the study published in Science Translational Medicine, (1) the researchers examined the mechanisms of pain in both humans and mice. They found that neutrophils – a type of white blood cell that helps the body fight infection – play a key role in resolving pain.
“In analyzing the genes of people suffering from lower back pain, we 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,” says Luda Diatchenko a Professor in the Faculty of Medicine, Faculty of Dentistry, and Canada Excellence Research Chair in Human Pain Genetics.
Inflammation plays a key role in resolving pain
“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,” says Professor Mogil, who is also a member of the Alan Edwards Centre for Research on Pain along with Professor Diatchenko.
Experimentally blocking neutrophils in mice prolonged the pain up to ten times the normal duration. Treating the pain with anti-inflammatory drugs and steroids like dexamethasone and diclofenac also produced the same result, although they were effective against pain early on.
These findings are also supported by a separate analysis of 500,000 people in the United Kingdom that showed that those taking anti-inflammatory drugs to treat their pain were more likely to have pain two to ten years later, an effect not seen in people taking acetaminophen or anti-depressants.”
Doses of anti-inflammatories. In the many years that we have treated patients with degenerative joint disease, there has always been the instance when a patient will ask us if they can continue with their anti-inflammatory medications. The answer is typically no. When the patient asks why? We have to remind them that regenerative medicine techniques like the ones we use, count on the beneficial aspects of inflammation. Inflammation is the way Nature heals. If we stop the inflammation, we stop the healing.
While NSAIDS can make knees feel better in the short-term, more and higher doses are needed to in the long-term to achieve similar results. In the over 25 years that we have treated patients with knee problems, there has always been the instance when a patient will ask us if they can continue with their anti-inflammatory medications. The answer is typically no. When the patient asks why? We remind them that regenerative medicine techniques like the ones we use, count on the beneficial aspects of inflammation. Inflammation is the way Nature heals. If we stop the inflammation, we stop the healing.
“The clinical management of inflammatory pain requires an optimal balance between effective analgesia and associated safety risks.”
A recent paper wrote: “Existing guidelines for pain management provide recommendations that do not satisfactorily address the complex nature of pain. To achieve optimal outcomes, drug choices should be individualized to guarantee the best match between the characteristics of the patient and the properties of the medication. NSAIDs represent an important prescribing choice in the management of inflammatory pain, and the recent results on paracetamol (Tylenol) question its appropriate use in clinical practice, raising the need for re-evaluation of the recommendations in the clinical practice guidelines.” (4)
The reality of anti-inflammatory use and how doctors can help
A March 2022 paper (2) writes about the reality of anti-inflammatory use and how doctors can help: “The use of NSAIDs in osteoarthritis treatment, either planned by a medical professional or taken of the patients’ own accord, is very high. Two-thirds of the (study) population affected by osteoarthritis are over 65 (which is the standard age of retirement in Hungary), which carries the risk of comorbidities and the parallel use of several medications, but a considerable fraction of osteoarthritis patients is still active, for whom immediate and long-lasting pain management is both medically and financially important. Both general practitioners and specialists need to familiarize themselves with their patients’ pain management habits and make a comprehensive and personalized plan for the management of osteoarthritis patients.”
Non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, intra-articular corticosteroid injections are of little value in the long term, and opioids may have ominous consequences.
A study from 2022 (3) writes about the need for new knee pain treatments: “Non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, intra-articular corticosteroid injections are of little value in the long term, and opioids may have ominous consequences. Radiotherapy of knee osteoarthritis has no added value. Physical therapy, exercises, weight loss, and lifestyle modifications may give pain relief, improve physical functioning and quality of life. However, none of them has articular cartilage regenerating potential. . .(in this paper the researchers) focus on emerging osteoarthritis knee treatments, relieving symptoms, and regenerating damaged articular cartilage that includes intra-articular human serum albumin, conventional disease-modifying anti-rheumatic drugs (DMARDs), metformin, lipid-lowering agents (statin), nerve growth factors antagonists, bone morphogenetic protein, fibroblast growth factors, Platelet-Rich Plasma (PRP), Mesenchymal Stem Cells (MSC),” and other treatments. We will be discussing some of these treatments in this article and the research published by other investigators.
Do you have questions about your treatment options? Ask Dr. Darrow
References:
1 Parisien M, Lima LV, Dagostino C, El-Hachem N, Drury GL, Grant AV, Huising J, Verma V, Meloto CB, Silva JR, Dutra GG. Acute inflammatory response via neutrophil activation protects against the development of chronic pain. Science Translational Medicine. 2022 May 11;14(644):eabj9954.
2 Mezey GA, Máté Z, Paulik E. Factors influencing pain management of patients with osteoarthritis: A cross-sectional study. Journal of Clinical Medicine. 2022 Mar 1;11(5):1352.
3 Cao X, Cui Z, Ding Z, Chen Y, Wu S, Wang X, Huang J. An osteoarthritis subtype characterized by synovial lipid metabolism disorder and fibroblast-like synoviocyte dysfunction. Journal of orthopaedic translation. 2022 Mar 1;33:142-52.
4 Varrassi G, Alon E, Bagnasco M, Lanata L, Mayoral-Rojals V, Paladini A, Pergolizzi JV, Perrot S, Scarpignato C, Tölle T. Towards an effective and safe treatment of inflammatory pain: a Delphi-guided expert consensus. Advances in Therapy. 2019 Oct;36(10):2618-37.