Inflammation & Pain

Inflammation – a word that Fibromyalgia and ME/CFS patients know all to well – and feel way too much of in our bodies all of the time. As a Fibromyalgia and ME/CFS patient, blood tests always reveal that my body has high levels of inflammation. But what is inflammation exactly? The best definition I could find that was in layman’s terms (MedicineNet.com) defines inflammation as:

A basic way in which the body reacts to infection, irritation or other injury, the key feature being redness, warmth, swelling and pain. Inflammation is now recognized as a type of nonspecific immune response.

Inflammation is one way the body heals.  But when inflammation continues in the body, it can cause chronic health problems, as many of us have seen.  Studies have shown that chronic inflammation can lead to arthritis, lung and heart diseases. 

The American Pain Foundation recently interviewed two physicians, Dr. Steven Stanos, rheumatologist/pain specialist, and Dr. Rowland Chang, medical director of the Rehabilitation Institute of Chicago Arthritis Center.  Both of these expert physicians asked a number of questions on inflammation and I found the article really interesting and wanted to share excerpts of it with my readers.  I will include the link for you to read the full article at the end of the post.

What is inflammation?

Dr. Steven Stanos, DO (SS):  Familiar signs of inflammation include redness, warmth, pain and swelling. Inflammation is a normal process of the body trying to heal itself. During a normal inflammatory response the nociceptors or pain receptors in the tissue are bombarded with different chemicals; these chemicals are there to help restore the healing process.

With any kind of inflammation – whether it’s from a bug bite, an infection, acute trauma or an inflamed joint, for example � there is an upregulation of the pain receptors so the tissue may be more sensitive. That’s why you’ll see redness and swelling and those are related to the chemical changes triggered by this inflammatory response.

The problem is that, over time, the process of inflammation can repeat itself even when you no longer need it. So there is a balance between inflammation that is good and useful to the body versus ongoing inflammation that can cause more signs and symptoms, and lead to pain and other dysfunction.

If inflammation isn’t useful, we need to be more aggressive in treating it. But we must remember, there is a very complex cascade of events that are triggered from inflammation. Different medicines are designed to work on different pathways of inflammation.

What is inflammatory pain?

Dr. Rowland Chang, MD, MPH (RC):  Simply stated, inflammatory pain is pain that is associated with an inflammatory condition. It is often part of a clinical picture that includes swelling, warmth, redness, and stiffness. Inflammatory musculoskeletal pain is commonly worse first thing in the morning and/or after long periods of immobility, and it generally improves after periods of physical activity.

What are the most common causes of inflammatory pain?

RC: Infections are probably the most common overall cause of inflammatory pain. Common causes of inflammatory musculoskeletal pain include many of the rheumatic diseases, such as rheumatoid arthritis and other inflammatory forms of arthritis (such as psoriatic arthritis and ankylosing spondylitis � an inflammatory arthritis of the spine), polymyalgia rheumatica (an inflammatory condition in older people that results in profound morning stiffness, shoulder and hip pain), systemic lupus erythematosus (a systemic inflammatory condition affecting the joints, skin and many internal organs), and so on.

How is inflammatory pain different from other pain types?RC: As mentioned, inflammatory pain generally gets worse after prolonged immobility and better after physical activity. In contrast, neuropathic or nerve pain is generally constant. And mechanically driven musculoskeletal pain tends to get worse during physical activity and/or standing and better after rest, the opposite of what you would expect from inflammatory musculoskeletal pain.

SS: We classically think of inflammation as nociceptive pain – it’s considered “normal” pain or the body’s normal response to trauma or injury. We’ve always had this dichotomy between nociceptive pain versus neuropathic pain. But I think now most pain conditions are mixed. We are beginning to understand there is a lot of overlap between the mechanisms of nociceptive and neuropathic pain and changes across the entire nervous system.

For example, shingles pain in which the virus is reactivated and spreads all along the nerve will cause a very severe inflammatory response along the course of the nerve.

Another example is a disc herniation when the disc pushes on a nerve in the back and that can cause severe leg pain or sciatica. Different chemicals are released in the area and there is inflammation, which is why we would use steroids to try to decrease the pain.

Q: How are laboratory tests, specifically markers of inflammation found in the blood like erythrocyte sedimentation rate and C-reactive protein (CRP) levels, used to help track inflammation in people with chronic pain?RC: Erythrocyte sedimentation rate (ESR or sed rate for short) and CRP tests can be used to follow inflammatory conditions and can be useful in helping to distinguish inflammatory versus noninflammatory conditions, but these are not perfect tests. Positive tests could occur in persons without inflammation (false-positives) and negative tests can occur in persons with inflammation (false-negatives).

Q: What can someone do to help safely reduce inflammation?

RC: Treating the cause of the inflammation is the best way of treating inflammation. If it is due to an infection, using antibiotics will help combat the inflammation. If infection is not the cause, then a variety of non-steroidal anti-inflammatory drugs (for example, ibuprofen) can be tried.

Occasionally corticosteroids (prednisone is an example) are used when the inflammation is particularly severe and it leads to functionally limiting consequences (for example, when the inflammation of rheumatoid arthritis becomes so intense that a patient cannot function at an acceptable level), but this must be done with great caution because of the potential side effects of these medicines.

Chronic inflammation can also be improved with the use of omega-3 fatty acid supplementation and probably with moderate intensity physical activity (for example, fast-paced walking or swimming).

However, physical activity can worsen acute inflammatory conditions, so rest is generally advised when an infection or other acute inflammatory conditions (for example, gouty arthritis or an acute asthma attack) occur.

If you suspect acute inflammation or if chronic inflammation appears to be worsening, you should consult your health care provider.

SS: It depends on the root cause of the inflammatory response, as Dr. Chang mentioned. If we are talking about reducing inflammation from an injury, it’s important to apply ice to the area which may help decrease some of the swelling.

You also want to keep the joint mobile with an inflammatory reaction, because if you don’t move the joint, the joint capsule and related tissue may contract and get tighter, which can lead to more pain. So applying ice, trying to remain active and maintaining range of motion of the joint are all important.

Inflammation can also be a sign there is a biomechanical problem.

Stretching and strengthening the muscles above and below the joint that is inflamed can reduce the pressure through the joint and reduce inflammation. As a rehab physician, if there are signs that there is a biomechanical deficit and you don’t address that, inflammation is going to continue. If this is the case, medications can only help so much.

Physical medicine physicians and therapists can work with patients to help restore normal function and improve structure and tissue function around the joint.>

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