The researchers also replicated the results in mice, compressing the animals’ sciatic nerves to produce back and leg pain or injecting an irritant into the sciatic nerves. When they blocked the animals’ immune response with dexamethasone, a steroid commonly used to treat back pain, the pain became chronic.
Six tips for dealing with chronic pain
Next, the group discussed whether chronic pain resulted from suppressing pain or suppressing inflammation. So they gave some mice a prescription anti-inflammatory, diclofenac. Other mice were given one of three other analgesic or analgesic drugs – gabapentin, morphine and lidocaine.
Only with diclofenac did the pain persist, becoming chronic.
These findings led them to wonder: Were patients who took nonsteroidal anti-inflammatory drugs like ibuprofen or steroids like dexamethasone for back pain also more likely to develop chronic pain?
The researchers turned to data from the UK Biobank, a repository containing information on the medical conditions and drug use of half a million patients. They studied 2,163 people with acute back pain, 461 of whom went on to experience chronic pain. The researchers found that those taking a nonsteroidal anti-inflammatory drug were almost twice as likely to develop chronic back pain as those taking no or no medication.
Dr. Diatchenko said she does not believe her findings address the issue of opioid addiction. In fact, she says, “to avoid opioids, clinicians have started prescribing more nonsteroidal anti-inflammatory drugs.”
“We need to think more about how to treat our patients,” she said.
The tendency to use nonsteroidal anti-inflammatory drugs persists despite their poor performance. An analysis of randomized clinical trials found that these drugs had almost no benefit over placebos in reducing low back pain.
Dr. Atlas says that short-term use of nonsteroidal anti-inflammatory drugs is probably not harmful, but the new study, he adds, without proving that long-term use is harmful, “gives at least one biological mechanism that says short-term use isn’t as long-term.