Pain Killers Causing More Pain?

New peer-reviewed science suggests anti-inflammatory drugs and steroids may cause more pain than they relieve

With major changes to how we work, such as working from home, our posture might be affected if we do not take the time to work on our posture, and reduce back pain. (Shutterstock)

Your 12-year-old daughter says her stomach hurts. Your 50-something spouse complains of a headache. Then there’s your own joint pain: the dull ache just below your elbow, perhaps from spending too much time typing on a computer keyboard, and your sore hips from the slow jogging you’ve been doing to keep in shape.

“Pain is a near-universal experience,” the authors of a 2019 systematic review about western medicine’s understanding of pain assert. Because so many of us are plagued with so much pain, healthcare practitioners in every country are always looking for ways to help patients alleviate it. ⁽¹⁾

Big Pain

But pain relief is also a multi-billion-dollar business.

Data from the Drug Enforcement Administration shows that America’s largest pharmaceutical companies flooded the country with 76 billion opioid pain pills between 2006 and 2012 alone, according to a Washington Post investigation. ⁽²⁾

Pharmaceutical companies incentivize doctors to aggressively treat and manage pain in order to maximize their profits. And Big Medicine has been especially successful at selling highly addictive opioids to the public, essentially creating customers for life. ⁽³⁾

What do you do when you feel pain? The drug companies would like you to pop a pill (or two or three)—whether those pills are prescription medications or over-the-counter drugs. The pills alleviate your pain. Problem solved.

Not so fast. A new study, “Acute inflammatory response via neutrophil activation protects against the development of chronic pain,” suggests that two anti-inflammatory drugs often used for chronic pain may actually make the pain worse. ⁽⁴⁾

Clinical data collected for this study, as we will explain, associated the use of anti-inflammatory medication with increased risk of persistent pain. If this science is correct and can be replicated, it suggests that the pain relievers you’ve been taking are actually be exacerbating your pain.

Are You Experiencing Chronic Pain?

Chronic lower back pain is the most frequently reported chronic pain condition. Persistent lower back pain affects approximately 8 percent of American adults, or 16 million people.

Another 15 million Americans experience severe joint pain associated with arthritis, about half of them reporting “persistent” pain. ⁽⁵⁾

In addition, fibromyalgia, a condition characterized by chronic body-wide pain and extreme fatigue, affects approximately 2 percent of American adults, according to the CDC. ⁽⁶⁾

That’s a lot of people experiencing a lot of pain.

However, despite the fact that so many millions of people suffer from persistent pain, until now not a lot has known about how acute pain—a sudden, sharp, one-time feeling that often serves as your body’s warning signal that something is amiss—becomes chronic pain.

Chronic pain has recently come to be understood as a complex interplay between the central nervous system and the immune system.

Enter this new study, published in the journal Science Translational Medicine, which provides some surprising new clues that may well revolutionize the way we think of and treat acute as well as chronic pain.

New Research: How Acute Pain Becomes Chronic

Led by Drs. Jeffrey Mogil and Luda Diatchenko at McGill University in Montreal, Canada, and Massimo Allegri, a physician in Italy, a team of twenty scientists conducted a series of experiments intended to illuminate the physiological mechanisms responsible for the progression from acute pain to chronic pain.

They analyzed the gene expressions of 98 people afflicted with acute low back pain at an initial point in time and then again three months later.

At the initial evaluation, the subjects rated their pain on an average of 6.8 on a scale from 0 to 10, with the minimum being 4 and the maximum 10. The first thing the researchers noticed at follow-up was that the average had dropped to 3.2, but the range of pain had expanded to 0 to 10.

The scientists then divided the subjects into two groups of 49 based upon their pain ratings at follow-up.

The group with the lower average pain rating was considered to have “resolved” pain and labeled “R.” The group reporting higher pain at follow-up was labeled “P” for “persistent” pain.

Then the researchers compared the gene expression between the two groups during two visits. At the first visit, “there were no differentially expressed genes that reached genome-wide statistical significance between R and P patients”.

But at the second visit—and here’s where it gets interesting—there were over 1,700 genes “differentially expressed” at “the genome-wide scale.”

In general, inflammatory genes were up-regulated (meaning more active) at the start of the study and down regulated (less active) at the end for the R group, while no changes were noted in the P group.

In other words, something was happening in the bodies of the people whose pain was gone that was not happening in the people with persistent pain.

Because of the expression level changes in genes related to inflammatory pathways, the scientists looked specifically at several types of immune cells. They found significant differences between the two groups in certain cells: neutrophils, CD8+ T cells, natural killer cells, and mast cells.

The effect was particularly pronounced for neutrophils, a type of white blood cell that is called to areas of tissue damage.

While neutrophils decreased for both groups, the pain resolvers had much higher levels of neutrophils at the start and experienced a much sharper drop over the three months.

Jaw Pain

So, to see if their results were more generally true of chronic pain, the scientists decided to replicate their analysis with a group of people suffering from temporomandibular disorder (TMD).

TMD is an increasingly common disorder, affecting up to 15 percent of adults. TMD refers to jaw pain that is associated with the muscles, joints, and nerves around your jaw. ⁽⁷⁾

TMD pain was resolved at the three-month mark for some of the subjects, just as it had been for back pain subjects. Tellingly, about 80 percent of genes associated with neutrophils were more expressed in the resolved groups with both lower back pain and TMD patients.

What do all these details means? It appears that the initial inflammatory response is very important to the resolution of acute pain.

To test whether that was indeed the case, the scientists then carried out experiments in mice.

Steroid Injections Increase Pain Over Time

They injured mice, to cause them pain, and then injected dexamethasone, a powerful immune-suppressing steroid, into some the mice for six days and a placebo (in this case a saline injection) into other mice.

As The Epoch Times reported in July of 2020, dexamethasone has demonstrated positive effects in the treatment of COVID-19. The National Institutes of Health, in a treatment guideline last updated in December 2021, recommended it or other systemic corticosteroids as an effective treatment for both hospitalized and non-hospitalized COVID-19 patients. ^{(8) (9)}

However, the mice given steroids fared poorly: their pain increased over time. To test whether this was because of the anti-inflammatory nature of the dexamethasone steroid treatment or because of some other component of the pain-relief action, the scientists also tested the Non-steroidal anti-inflammatory drugs (NSAID) diclofenac, and three pain-relievers with no known anti-inflammatory action: gabapentin, morphine, and lidocaine.

Only the anti-inflammatory, diclofenac, significantly prolonged the rodents’ pain.

Is Inflammation Beneficial?

In the mice experiments, early treatment with both steroid and nonsteroidal anti-inflammatory drugs alleviated pain in the short-term but led to prolonged pain in the longer term.

In addition, when the scientists purposefully destroyed the rodents’ neutrophils with injections of an antibody, the mice also experienced longer-term pain.

“Inflammation is painful, but this inflammation is needed for our body to resolve pain,” molecular biologist Luda Diatchenko, M.D./Ph.D., corresponding author on the study who is a professor in the Faculty of Medicine in the Department of Anesthesia at McGill, told the New Scientist. “Pain resolution is an active process that requires neutrophil activation.” ⁽¹⁰⁾

The take home message in all of this: Decreasing acute inflammation, either with the use of steroids or with the use of NSAIDs, may have lasting negative long-term effects.

This science indicates that the reason may be that our bodies’ neutrophils, which are inhibited by these pain management techniques, are necessary to prevent the development of long-lasting pain.

But What Do You Do If You’re Feeling Pain?

While Western medical models favor “a pill for every ill,” other healing modalities, including traditional Chinese medicine, Ayurvedic medicine, and alternative healing in the West, look to treat pain by addressing both the mind and the body.

If your 12-year-old has a stomach ache, the pain is real, but the cause might be psychological: a problem with a teacher or a friend at school, for example. Or the tummy troubles may also hormone or diet-related. Instead of pain relievers, the cure in this case would be to address the issues at school, eliminate the processed and junk foods that are causing the trouble, and also make lifestyle changes to your child is not being over-exposed to so many endocrine-disrupting chemicals.

For your spouse who is suffering from pain, acupuncture might be the first thing to try, as treatments have been shown to be effective at alleviating both headaches and back pain.

Consider this: A 2012 meta-analysis about using acupuncture to manage chronic pain, published in JAMA Internal Medicine, demonstrated that acupuncture is helpful in the treatment of low back pain, headaches, and osteoarthritis. It has also been shown to have other health benefits, including improving blood pressure and brain function. ⁽¹¹⁾

What’s also interesting is that several studies, including a placebo-controlled single-blinded 2003 study done in Germany, have shown that acupuncture increases neutrophil activity. ⁽¹²⁾

And that elbow pain you’re having? If, indeed, it is caused by too much typing, you should be able to alleviate it by a combination of acupuncture treatments, massage, and setting up a more ergonomic computer desk. Tai chi, too, has been shown to be effective in helping with hip flexibility and arthritis-associated pain, as The Epoch Times previously reported. ⁽¹³⁾

Falun Gong

In 2005, a biochemical analysis of the blood of six Asian practitioners of Falun Gong, an ancient Chinese Qigong, found that the practice also had a beneficial effect on—you guessed it—neutrophils compared to six Asians who did not engage in the practice. ⁽¹⁴⁾

It is theoretically “easier” to have a steroid injection or take a pill. But identifying root causes and embracing non-pharmaceutical approaches to fix chronic pain are likely more effective solutions in the long-term.

References

1. Arthur, Luke; Rolan, Paul. “A systematic review of western medicine’s understanding of pain experience, expression, assessment, and management for Australian Aboriginal and Torres Strait Islander Peoples,” PAIN Reports: November/December 2019 - Volume 4 - Issue 6 - p e764. https://journals.lww.com/painrpts/fulltext/2019/12000/a_systematic_review_of_western_medicine_s.3.aspx
2. https://www.washingtonpost.com/investigations/76-billion-opioid-pills-newly-released-federal-data-unmasks-the-epidemic/2019/07/16/5f29fd62-a73e-11e9-86dd-d7f0e60391e9_story.html
3. https://www.theepochtimes.com/drugmaker-teva-fueled-opioid-addiction-in-new-york-jury-finds_4238069.html
4. Parisien, Marc, et al. “Acute Inflammatory Response via Neutrophil Activation Protects against the Development of Chronic Pain.” Science Translational Medicine, vol. 14, no. 644, 2022, https://doi.org/10.1126/scitranslmed.abj9954.
5. https://www.cdc.gov/arthritis/pain/index.htm
6. https://www.cdc.gov/arthritis/basics/fibromyalgia.htm
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8. https://www.theepochtimes.com/mkt_app/dexamethasone-a-cheap-steroid-may-help-patients-with-severe-covid-19-study_3429231.html
9. https://www.covid19treatmentguidelines.nih.gov/therapies/immunomodulators/corticosteroids/
10. https://www.newscientist.com/article/2319844-some-medicines-prescribed-to-treat-back-pain-may-prolong-the-problem/
11. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis. Arch Intern Med. 2012;172(19):1444–1453. doi:10.1001/archinternmed.2012.3654
12. Karst, M., et al. “Effect of Acupuncture on the Neutrophil Respiratory Burst: A Placebo Controlled Single-Blinded Study.” Complementary Therapies in Medicine, vol. 11, no. 1, 2003, pp. 4–10., https://doi.org/10.1016/s0965-2299(02)00117-6
13. https://www.theepochtimes.com/how-not-to-have-a-hip-replacement_4371217.html
14. Li, Quan-Zhen, et al. “Genomic Profiling of Neutrophil Transcripts in Asian Qigong Practitioners: A Pilot Study in Gene Regulation by Mind–Body Interaction.” The Journal of Alternative and Complementary Medicine, vol. 11, no. 1, 2005, pp. 29–39., https://doi.org/10.1089/acm.2005.11.29