New Study Suggests Anti-Inflammatory Drugs May Impede Resolution of Back Pain

Sarasota, FL (WorkersCompensation.com) – One of the most common problems in the workplace is low back pain. Some estimates have shown that the total annual healthcare expenditures treating low back pain is around $90 billion each year in the U.S.

Studies have suggested the implications of low back pain are far reaching, leading to work and family imbalances, job insecurity, hostile work environments, and longer work hours. Females working over 40 hours per week, and younger workers who work over 60 hours a week are at greater risk of back pain, with healthcare and agriculture industries having the highest risk. Low back pain has been reported in over a quarter of workers, with around 27 percent of those being female.

The most common conservative treatment of low back pain, especially in cases where exercises and therapies don’t provide immediate relief, is the use of anti-inflammatory medications such as ibuprofen or steroids. While anti-inflammatory medications may offer initial relief, a new study from Canadian researchers published in Science Translational Medicine suggests that they may actually increase the risk of developing chronic pain.

In layman’s terms, inflammation is the body’s immune system’s response to a foreign object or irritant. The body sends inflammatory cells, white blood cells known as Neutrophils, to an area to start the healing process. This particular study suggests that inflammation is a normal part of recovery, and that to keep the inflammatory process from happening could result in ongoing pain that is more difficult to treat, as Neutrophils are responsible for healing damaged tissue and resolving infections.

Researchers compared data from studies done with mice assessing pain after a chronic constriction injury of the sciatic nerve. The mice were given anti-inflammatory steroids or analgesics without anti-inflammatory properties such as gabapentin, morphine, and lidocaine. In addition, the mice were injected with S100A8/A9 proteins normally released by neutrophils.

The researchers confirmed that while the anti-inflammatory medications were effective at greatly reducing the pain in the mice at the time of use, they also prolonged the inflammatory pain by as much as 10 fold. By contrast, the researchers found that three analgesics without inflammatory properties did not affect pain duration. Additionally, the researchers determined from the protein injections that neutrophils prevented the development of chronic pain that had been induced by the anti-inflammatory medications.

In addition to the mice studies, the researchers selected 50 patients with resolved pain, and 50 patients with persistent pain. A total of 98 patients made the final review and were followed for 3 months. The patients were classified by six classes including facet joint pain, sacroiliac pain, discogenic pain, spinal stenosis, back pain with predominate radiculopathy, and nonspecific. The patients received treatments that included non-steroidal anti-inflammatory drugs, systemic steroids, and opioids if needed for pain. 

In reviewing the blood specimens, the researchers found that those with resolved low back pain had high inflammation levels as indicated by high neutrophil levels. The researchers felt that the findings substantiated the findings from a previous the UK Biobank project study that suggested those taking a non-steroidal anti-inflammatory drug had an increased risk of reporting back pain within 2 to 6 years later.

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