May 11, 2022

expert reaction to study looking at inflammation, pain and NSAIDs

A study published in Science Translational Medicine looks at the acute inflammatory response and chronic pain.

Dr Franziska Denk, Senior Lecturer, King’s College London, said:

“How exactly inflammation impacts chronic low back pain is a crucial question, and the authors are to be commended for generating a big dataset in this space.

“This study is a wonderful start to providing an answer to this question, but it now needs to be replicated and further investigated by other scientists.

“It would most definitely be premature to make any recommendations regarding people’s medication until we have results of a prospectively designed clinical trial. In my opinion, this study should not generate a debate around the use of NSAIDs in low back pain – much more research is needed to confirm these findings first.

“While the current study is large for its type, it had to consider many different variables, which always elevates the risk of a statistical fluke.

“The findings are very intriguing for other scientists like myself, and highlight how important it is that we spend time and money to properly dissect immune cell function in chronic pain.”

Prof Blair Smith, Chair in Population Health Science, University of Dundee, said: 

“This is excellent science, from an excellent group of researchers. 

“They not only found that factors associated with the normal inflammatory response were likely to protect people with acute back pain from transition to chronic back pain but also tested the hypothesis by seeing if artificial reduction of inflammation led to prolonged pain in mice, which it did. They then tested whether drugs known to dampen inflammation were associated with long-term pain in humans, which proved to be the case. 

“The theory is that inflammation may have a protective effect in the long-term, and that overly reducing inflammation may be harmful. However, it is important to note that this is just one study, and more research is needed to confirm and investigate this further. It is also important to note that anti-inflammatory drugs are effective in short-term pain management. There is good quality evidence to back this up and they should not be withheld unnecessarily. Anti-inflammatory drugs have a number of other potentially dangerous side effects, and their long-term use is generally discouraged, other than with caution.”

‘Acute inflammatory response via neutrophil activation protects against the development of chronic pain’ by Marc Parisien et al. was published in Science Translational Medicine at 19:00 UK time on Wednesday 11th May 2022.

DOI: 10.1186/eabj9954

Declared interests

Dr Franziska Denk: I have none to declare.

Prof Blair Smith: No relevant conflicts of interest