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