Regular treatment for back pain can make it worse |  CBC News

Regular treatment for back pain can make it worse | CBC News

A study led by researchers at McGill University and scientists from Italy suggests that blocking inflammation after an injury may make this pain chronic — a finding that challenges the standard approach to treating pain.

Chronic pain – especially in the lower back – is a common ailment, but scientists don’t know why some back injuries heal on their own while others cause years to suffer.

In this study, researchers found that neutrophils, a type of white blood cell that helps the body fight infection and control early stages of inflammation, play a key role in treating pain.

Standard medical practice for treating short-term pain after an injury may be the opposite of what we should be doing, says Jeffrey Mogill, a study researcher and professor of psychology at McGill University.

“We think that chronic pain develops because of inflammation, so we think the inflammation is bad and we should stop it. But what this study suggests is that yes, but at the cost of increasing the chances of developing chronic pain,” Mogill said.

While the results have yet to be tested in humans in a clinical trial, many pain experts unaffiliated with the study say they point to a new way of looking at how the body heals.

Blood cell test and mice

The study, which was published in Translational Medicine Sciences Last Wednesday, nearly two dozen researchers conducted the pain test in three stages, using human blood cells and mice experiments

They examined the blood cells of 98 patients with acute low back pain and looked for signs of inflammation. Three months later, they did the same test – comparing those who still had persistent pain and those who didn’t.

The patients whose pain was gone showed more inflammation at the first visit, which appeared to be caused by neutrophils, a type of white blood cell. On the second visit, their blood cells showed a change in gene expression in several thousand genes.

The findings challenge what has become a standard treatment for short-term pain, says Jeffrey Mogill, a neuroscientist and professor of psychology at McGill University. (McGill University)

“People who didn’t resolve their pain, absolutely nothing happened in their blood,” said Dr. Luda Dyachenko, another study researcher and professor of dentistry and medicine at McGill University. She said both groups of patients used anti-inflammatory drugs.

The researchers tested it on mice and confirmed that blocking inflammation with drugs relieved pain in the short term, according to their sensitivity to touch. But the drugs prolonged their pain – turning acute pain into something more chronic.

In the latest phase of the study, they examined data from 500,000 people from the UK Biobank, a database of medical information obtained from half a million volunteers.

The researchers found that those taking anti-inflammatory drugs, such as ibuprofen, naproxen, and diclofenac to treat their pain, were more likely to develop pain two to 10 years later — an association that is consistent with their other findings, but they can’t pinpoint the cause. Constant pain.

By comparing blood samples between patients whose pain was resolved and those whose pain was not, the scientists found that the people whose pain was gone had more inflammation from neutrophils, a type of white blood cell. (Louis Marie Philidor/CBC)

They also found that those who took other painkillers, such as acetaminophen (Tylenol), were less likely to have chronic pain than those who took anti-inflammatory drugs.

Study should be taken seriously, says pain doctor

About 18 percent of the population has chronic back pain, says Dr. Hans Clark, medical director of the Pain Research Unit at Toronto General Hospital.

Even without the randomized clinical trials, Clark said there are implications for understanding what happens differently between acute and chronic pain.

“This is a beautiful historical find,” he said in an interview with CBC News.

“To find a molecular basis relating to those who have a chronic pain problem versus those who will avoid it, needs to be taken seriously.”

Clark says the primary treatment for a back injury should be heat, physical therapy, stretching, massage, and then potentially medication.

“What these researchers have shown is that, you know, we can try medications other than anti-inflammatories first,” he said.

Dr. Hans Clark, director of pain services at Toronto General Hospital, says the study has findings that need to be taken seriously when it comes to chronic pain. (Dr. Hans Clark)

Clark says there is a normal immune response that should occur after an infection.

“We still need to figure out what point in time we have to interfere with this natural process, because obviously if you have a high number of these white cells … you might do better in the long run,” he said.

But until the results are tested with human trials, Clark still advises patients who can’t get out of bed because of the pain to take an anti-inflammatory drug to help themselves function again.

“We don’t want the message to be… You have to be in intractable pain for a long period of time because that’s the natural process,” he said.

Clinical trials are coming

Clark says that about 90 percent of people with an acute injury will find their pain goes away.

Stephen Katz, who lives in Toronto, accounts for the remaining 10 percent; He’s had pain in his lower back for years, and an act as simple as picking up a pencil can cause a flare-up.

Steve Katz suffers from chronic low back pain. With the results of this study, he says he may wait longer before reaching for anti-inflammatory drugs during his next breakout. (Mark Buchler/CBC)

“It’s kind of like a stabbing pain and it gets to the point where I can’t really walk,” he said.

Katz visits his physical therapist, Lauren Roberts, often for exercises and acupuncture. But on days when he can’t get out of bed, he looks for medication like Robax and Advil.

After hearing about this study, Katz says he may wait longer before taking a pain medication.

“I am not surprised… at the same time I am sensitive to pain,” he said. “It depends on the level of pain, frankly.”

Roberts, who founded the Running Physio Clinic in Toronto, says she’s not surprised by the study results either — especially since similar discussions have been taking place in the field of sports medicine. in 2015.

Physiotherapist Lauren Roberts, who founded the Running Physio Clinic in Toronto, says the field of sports medicine also discusses the positive role inflammation may play in healing. (Mark Buchler/CBC)

“There may be a negative side effect of taking NSAIDs [non-steroidal anti-inflammatory drugs], especially earlier in the inflammatory cycle occurring in the body. Roberts said people don’t like hearing that.

“Those first 24 to 48 [hours]I’d say if you can get past it, try to see if you can.”

Mogil says the team is preparing to confirm their work through Randomized controlled trials with humans.

“What we’re saying here is very radical,” he said. “It overturns decades of standard practice and extraordinary claims require extraordinary evidence.”

“We used to mainly care about what produced the pain and all the research was on that, and I think now more people are realizing that maybe the better idea, is to try to figure out why the pain is gone.”

2022-05-20 10:38:19

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