Pain Management: Inflammation

New RNA research followed by clinical trials is reflecting for the first time that the current and decades-old approach towards inflammation may be wrong. Previously, there has been some questioning of the standard assumption that inflammation causes pain. The orthopedic doctor who coined the acronym "Rest Ice Compress Elevate" has since written about how that approach (although popular) is faulty. Before 2018 the technology didn’t exist to look at the DNA inside cells responding to pain. Stat News reports that when RNA technology became available, one researcher, Luda Diatchenko, took an up-close look. What she found goes against everything we thought we knew about inflammation and pain. Inflammation is a cellular response to pain. But treating inflammation doesn’t yield a faster recovery. Correlation is not the same as causation; and in this case, we’ve been treating inflammation as if it’s the cause of pain, instead of just a consequence. Taking this cellular discovery further, the clinical trials supported Diatchenko’s findings. Previous studies with mice have focused on immediate results, and not long-term consequences of using anti-inflammatories. In a new trial, the mice receiving an anti-inflammatory showed short-term benefits. However, keep watching a couple of weeks later and it was the mice with the anti-inflammatory that still flinched when their paw was touched while the mice that got saline instead were recovered. (I would hate to find out what researchers did to hurt the mouse’s paws.) A human study with bloodwork showed a similar pattern. Those who were treated with anti-inflammatories showed initial signs of recovery, but it took them 150 days to fully recover instead of two weeks like their counterparts who did not use anti-inflammatories. This re-examination of a hard-and-fast rule that treating inflation treats pain rocks the foundation that pain management has been built on for decades. Other areas have started to question if treating inflation is the answer – recently hand surgeons changed the opinion that carpal tunnel was caused by inflation, and now it appears to be more likely a genetic trait when a person’s carpal tunnel is too small. Studies with athletes have shown similar results in using ice therapy or an ice bath for performance. Exercise is highly inflammatory, and yet it has regenerative effects. So what to do? Inflammation is a mechanism that brings new fluid to the injured area and carries old dead cell tissue out. Tylenol treats pain without being an anti-inflammatory but ibuprofen is. Managing inflammation can bring some immediate relief, inhibiting the process deprives the injury of the nutrients it needs to regenerate. In light of new research, this may be a good time to rethink pain management.