The researchers also replicated the findings in mice, either by compressing the animals’ sciatic nerves to produce back and leg pain or by injecting the sciatic nerves with an irritant. When they blocked the animals’ immune response with dexamethasone, a steroid commonly used to treat back pain, the pain became chronic.
Six Tips for Treating Chronic Pain
The group then questioned whether chronic pain was the result of pain suppression or inflammation suppression. So they gave some mice a prescription anti-inflammatory, diclofenac. Other mice received one of three other analgesics or analgesics: gabapentin, morphine and lidocaine.
Only with diclofenac did the pain persist, becoming chronic.
Those results led them to wonder: Were patients who took NSAIDs 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 with 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 have chronic pain. Those taking a nonsteroidal anti-inflammatory drug were nearly twice as likely to develop chronic back pain as those taking other medications or taking no medication at all, the researchers found.
Dr. Diatchenko said she doesn’t think her findings are relevant to the issue of opioid addiction. In fact, she said, “to avoid opioids, doctors started prescribing more nonsteroidal anti-inflammatory drugs.”
“We need to think more about how to treat our patients,” he said.
The tendency to use nonsteroidal anti-inflammatory drugs persists despite their mediocre performance. An analysis of randomized clinical trials found that these drugs had almost no benefit over placebo in reducing low back pain.
Dr. Atlas says short-term use of NSAIDs is probably not harmful, but adds that the new study, while not proving long-term use is harmful, “at least provides a biological mechanism that says the short term use is not the same as long term.”