Why taking painkillers like ibuprofen can make you feel WORSE!
Millions of us regularly rely on them to keep us free from pain and discomfort — but could taking some over-the-counter painkillers actually mean we end up suffering even more?
That is the disturbing conclusion of new research by Canadian scientists who analysed what really happens to back-pain sufferers who use anti-inflammatory drugs such as ibuprofen or aspirin.
Absurd as it sounds, this latest research, published in the journal Science Translational Medicine, echoes several previous studies which suggest that, counter-intuitively, painkillers taken even for a few days may cause chronic symptoms by interfering with our bodies’ essential natural healing processes.
Around 24 million Britons suffer from chronic pain, according to the private healthcare charity Nuffield Health. In an attempt to solve such problems we spend more than £90 million on over-the-counter anti-inflammatory painkillers such as ibuprofen and aspirin every year.
But are we wasting our money? The new paper, from McGill University in Montreal, Canada, suggests inflammation that occurs, for example, in painful backs and joints — swollen, red and painful though it may be — actually helps resolve acute pain (the short-term discomfort we get from an injury).
It also prevents it from becoming chronic pain (defined as lasting longer than 12 weeks). And blocking that initial inflammation, while it might provide short-term pain relief, may interfere with this natural process and lead to harder-to-treat pain further down the line, the researchers warn.
The study analysed the health records of some 500 people with lower back pain in the UK Biobank database of health records from half a million Britons.
It found that those who were taking anti-inflammatory drugs such as ibuprofen to treat it were more likely to have pain for up to ten years later than those who didn’t take the anti-inflammatories. Indeed, this effect was not seen in people taking paracetamol — which dulls pain but does not dampen inflammation.
Why should this be so? The researchers also looked at pain mechanisms in both humans and mice and found that a type of white blood cell, known as a neutrophil, seems to play a key role.
Neutrophils are the most abundant white blood cells in humans and have multiple roles in our immune systems.
They capture and destroy invading microorganisms, but they can also be responsible for regulating levels of inflammation in response to an infection or injury, so that the inflammation helps healing but itself does not subsequently become over-active and cause damage.
They normally arrive on the scene of the injury early during inflammation when it starts to hurt — around the same time that many of us start taking painkillers. The McGill team blocked the action of neutrophils in mice with an injury and found the creatures’ pain subsequently lasted up to ten times longer than normal.
When they gave them anti-inflammatory drugs, despite providing short-term relief, they found they had the same pain-prolonging effect. The new research suggests it may be better not to block inflammation and instead allow the neutrophils to do their inflammation-damping work, says Jeffrey Mogil, a professor of pain studies at McGill University and one of the lead researchers.
‘Inflammation occurs for a reason and it looks like it’s dangerous to interfere with it,’ he says.
‘What we’ve been doing for decades not only appears to be wrong but 180 degrees wrong. You should not be blocking inflammation. You should be letting inflammation happen. That’s what stops chronic pain.’ Thus, we may be better off either taking painkillers that don’t block inflammation, such as paracetamol, or putting up with pain — if possible — in the reassuring knowledge that it’s actually part of our natural healing process.
It’s not the only new evidence that we might be better off without pills when we get a painful twinge. Last week, a major new study in the Journal of the American Medical Association concluded that the key to controlling chronic back pain lies in retraining the mind — not turning to tablets.
Scientists from the University of New South Wales, Australia, offered 138 back-pain sufferers a 12-week brain-retraining programme, where they underwent specific brain exercises to change the way they perceived their condition so it was no longer seen as a defect, or a barrier to movement.
Gradually, this allowed them to perform more and more physical movements — including lunges — that increased their strength and reduced their pain. The results showed that by the end of the course, pain scores had almost halved.
It’s not just over-the-counter painkillers that can make things even worse. The much stronger painkiller morphine, available only on prescription, can cause some patients to suffer chronic pain, a condition called opioid- induced hyperalgesia.
The prevalence of this is unknown, although a 2014 study in the British Journal of Anaesthesia warned that patients given high amounts of opioid drugs after surgery tend to suffer higher levels of post-operative pain, which can turn into long-term chronic pain.
In 2018, researchers from the University of Colorado at Boulder, U.S., reported that lab rats given opioids to quell pain after stomach surgery experienced pain for at least three weeks longer than rats not given opioids.
The report, in the journal Anesthesia & Analgesia, also found that repeated opioid doses can prime specialised immune cells in the spinal cord, called glial cells, to be more reactive to pain.
Perhaps worst of all, damning research suggests that using morphine to block the intense pain suffered during a heart attack may actually worsen people’s chances of survival. This is because the drug seems to prevent the body’s natural stem-cell repair system from working.
Normally, in response to the physical pain of a heart attack, the body sends stem cells to the damaged heart to repair damage and rebuild tissue. However, when this pain is blocked by morphine, the stem-cell repair response is also blocked off.
Professor Madeddu told Good Health that the new McGill University study on anti-inflammatory drugs and back pain ‘is different from ours on pain after a heart attack — but it has something in common as far as the suppression of the healing response is concerned’.
He adds that the loss of healing inflammation seems to be the problem, regardless of whether the drug is ibuprofen, aspirin or morphine.
‘Any injury can trigger the release of inflammatory-like cells,’ he says. ‘These cells have healing properties. In the case of heart attacks, blood cells promote healing by promptly stimulating the formation of new blood vessels, as in our Circulation paper. But if the response is blocked [by painkilling drugs] the initial acute injury and tissue damage can persist and become chronic.’
Dr Rajesh Munglani, a consultant in pain medicine at the Royal Papworth Hospital, Cambridge, agrees that inflammation, nasty though it might feel, is essential.
‘Inflammation is part of the healing process,’ he says, ‘This explains why long-term use of anti-inflammatory drugs can cause serious damage to the gut lining, because they inhibit the inflammatory response in the gut, which is part of the gut’s self-repair mechanism.
‘With anti-inflammatories you should take the smallest dose for the least possible time, because they are a blunderbuss that inhibits pain but also inhibits healing.’
Dr Munglani says that people who are taking anti-inflammatories long-term — for weeks and months rather than days — should try taking them only every other day. ‘Give yourself every other day off and try something else,’ he says. ‘If it’s chronic joint pain, for example, you can try putting icepacks on the painful sites and non-drug remedies, such as ginger and curcumin.
‘Chronic pain can have many biological causes as well as psychological ones,’ he adds. ‘Different remedies work for different people and, rather than relying on one drug, I recommend patients try a range of things to see what might work for them.’
But Dr Franziska Denk, who researches the nervous system’s involvement in chronic pain conditions at King’s College London, is more cautious about the new McGill University findings.
‘It’s a very interesting study, but it needs to be replicated in more detail to confirm its conclusions,’ she says. ‘I would not say we should take anti-inflammatory painkillers like Smarties. But if I had just put my back out, it would not put me off taking ibuprofen for around three days.
‘I wouldn’t use it for more than a few days though,’ she adds. ‘In general, it is not an easy drug to use — not only because of the risk of stomach ulcers but also because research evidence shows that if you take more than 15 ibuprofen doses a month you can increase your risk of migraine headaches.’ Professor Madeddu, however, says that for back pain we are best off avoiding anti-inflammatory drugs altogether — because they simply don’t work well. He says that several meta-analyses (where data from numerous previous trials is aggregated to produce numerically robust conclusions) show that the drugs bring only a ‘very modest’ reduction in acute pain symptoms.
These studies include a major survey by the authoritative Cochrane Library in 2020 of 32 previous research studies.
Instead, comprehensive large-scale studies, such as one by the University of Sydney in 2015 in the journal Annals of the Rheumatic Diseases, have recommended chronic back-pain sufferers engage in regular gentle exercise to build muscles that support and protect the back and help to salve injuries, which for some patients could include Pilates and yoga.
‘There is little evidence that anti-inflammatory drugs should be used to combat chronic pain,’ says Professor Madeddu.
‘Instead, it can be much more worthwhile investigating the reasons behind people’s chronic pain. It could be simply due to the fact these people continue to avoid following simple advice such as reducing body weight, doing proper exercise and maintaining correct posture at work and when resting.’
