Monday, November 28, 2022

Canadian study provides important clues as to why some back pain becomes chronic. Nation World News

A study by researchers at McGill University and scientists in Italy suggests that preventing inflammation after injury can make that pain chronic – a finding that challenges standard approaches to treating pain.

Chronic pain – especially in the lower back – is a common disease, but scientists do not know why some back injuries heal on their own while others cause years of pain.

In this study, researchers found that neutrophils, a type of white blood cell that help the body fight infection and dominate the early stages of inflammation, play an important role in relieving pain.

Study researcher and professor of psychology at McGill University, Jeffrey Mogil, says standard medical practice for treating short-lasting pain after injury may be the opposite of what we should be doing.

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

Although the findings have not been tested on humans in clinical trials, several pain experts who are not affiliated with the study say it suggests a new way of seeing how the body heals.

Blood cells and mice testing

study, which was published in science translation therapy last Wednesday, conducted by nearly two dozen researchers who examined pain in three phases using human blood cells and mice tests

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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 people who still had persistent pain and those who didn’t.

Patients whose pain was relieved showed more inflammation at first visit, which appeared to be driven by neutrophils, a type of white blood cell. On the second visit, his blood cells showed changes in gene expression in several thousand genes.

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

“Those who didn’t address their pain had nothing in their blood,” said another study researcher and professor of dentistry and medicine at McGill University, Dr. Luda Dyachenko said. Both groups of patients used anti-inflammatory drugs, she said.

The researchers tested them on rats and confirmed that using drugs to inhibit inflammation gave them short-term relief from pain, as evidenced by their sensitivity to touch. But the drugs prolonged the resolution of his pain – turning the acute pain into a more chronic one.

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

The researchers found that people who were taking anti-inflammatory drugs such as ibuprofen, naproxen and diclofenac to treat their pain were more likely to have pain after two to 10 years – a correlation that is consistent with their other findings, but Can’t determine what’s causing this. Ongoing pain.

Mcgill University Chronic Pain Study
By comparing blood samples between patients whose pain had resolved and those who did not, the scientists found that those whose pain was relieved showed a lot of inflammation driven by neutrophils, a type of white blood cell. had experienced. (Louis-Marie Philidor/CBC)

They also found that people who took other pain relievers 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

Dr. Hannes Clark, medical director of the Pain Research Unit at Toronto General Hospital, says that about 18 percent of the population struggles with chronic back pain.

Even without randomized clinical trials, Clark said understanding what differentiates between acute and chronic pain has implications.

“It’s a very historic discovery,” he said in an interview with Nation World News.

“To find a molecular basis that relates people who have problems with chronic pain who are going to avoid it, that needs to be taken very seriously.”

Clark says the main treatment for a back injury should be heat, physiotherapy, stretching, massage, and then potentially medication.

“What these researchers showed was that, you know, we can potentially test drugs other than anti-inflammatory first,” he said.

Dr Hance Clarke
Director of Pain Services at Toronto General Hospital, Dr. Hans Clark says the study has findings that should be taken seriously when it comes to chronic pain. (Dr. Hans Clark)

Clark says there is a natural immune response that needs to happen after an injury.

“We still really need to figure out at what time we should be interfering with that natural process, because it’s been shown clearly that if you have a high number of these white cells … that you can actually Can do better in the long run,” he said.

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

“We don’t want the message to be… you should be in unbearable pain for a long time because it’s a natural process,” he said.

Clinical trial is coming

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

Steven Katz, who lives in Toronto, is in the other 10 percent; His lower back has been hurting for years and a simple action like lifting a pencil can cause irritation.

Steve Katz
Steve Katz has been suffering from low back pain for a long time. With the findings of this study, he says, he may wait longer before reaching for anti-inflammatory medication during his next flare-up. (Mark Boxler/CBC)

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

Katz sees her physiotherapist, Lauren Roberts, often for exercises and acupuncture. But on days when he can’t get out of bed, he reaches for drugs like Robax and Advil.

Now hearing about this study, Katz says he may wait longer before taking his painkiller.

“I’m not surprised…. Plus, I’m allergic to pain,” he said. “It depends, obviously, on the level of pain.”

Roberts, who founded the Running Physio Clinic in Toronto, says he isn’t even surprised by the study’s findings—especially since similar discussions were taking place in the sports medicine field. in 2015,

Lauren Roberts
The sports medicine field is also discussing the positive role inflammation can play in healing, says physiotherapist Lauren Roberts, who founded the Running Physio Clinic in Toronto. (Mark Boxler/CBC)

“There might be a negative side effect of taking an NSAID. [non-steroidal anti-inflammatory drugs], especially earlier in the inflammatory cycle that occurs in the body. But people don’t like to hear that, Roberts said.

“That First 24 to 48″ [hours]I would say if you can overcome it, try it and see if you can.”

Mogil says team is preparing to confirm his work Randomized controlled trial with humans.

“What we are saying here is quite radical… it reverses decades of standard practice and extraordinary claims require extraordinary evidence,” he said.

“We originally cared solely about what caused pain and all the research was on that and now I think more people are realizing that maybe the better idea is to find out. Try to see why the pain goes away.”

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