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Inflammation Chronic Pain

What is all the fuss about “Inflammation?”

6 minute read

What is inflammation?

Most people have heard about “inflammation” in the context of food allergies, exercise pain, or arthritis, but few people understand what it means.  After all, we are bombarded with advertisements offering to “cure” inflammation, with images showing bright red areas on a body diagram, but they never explain.  Hopefully this helps.

Inflammation is a normal part of the immune system.  Inflammation in small amounts, and over a short period of time, is healthy.  The inflammatory response is your body’s reaction to things like a foreign invader (e.g., infection, toxins) or an injury (e.g., cut, bruise, sprain).  Your body sends specialized cells (e.g., platelets and white blood cells) to the area of concern.  The white blood cells release chemical messengers, called pro-inflammatory cytokines.  When this happens, the area may turn red, swell, become warm, or become painful.  Your body is fighting to isolate and cure the problem.  This is part of the normal healing process.

In most cases, it goes away after a short period of time (i.e., several days for minor injuries and infections, and a few weeks for more serious injuries).  This short-lived response is usually called acute inflammation.

Chronic inflammation

Chronic inflammation occurs when the body’s inflammatory response goes haywire; that is, the body sends out more messengers than usual and keep them activated for a longer period.  For example, when an infection lingers for an extended period, the immune response may persist causing more inflammation than necessary.  This results in damage to normal, healthy cells.  The newly injured healthy tissue further triggers an immune response.  This causes a seemingly endless loop in which inflammation causes damage to tissues in the body and that damage spurs further inflammation, and on and on.  This is a chronic inflammatory response.

This hyperactive response is unpredictable.  No two people are alike, and science has not identified a tipping point.  However, we know that it is multifactorial with contributions from genetics, environment, and diet (i.e., stress, poor diet, poor sleep, inactivity, and toxic exposure are some of the biggest contributors to chronic inflammation).  Each of these contributors cause their own immune/inflammatory response and may amplify a systemic inflammatory response.

Initially, cytokines with a pro-inflammatory function are elevated in infected or damaged tissue.  Over time, some of them increase systemically causing other problems (e.g., cardiovascular disease, muscle mass destruction, pulmonary edema, inflammatory bowel disease, rheumatoid arthritis, systemic inflammatory response syndrome).

Chronic inflammation is associated with the development and worsening of many physical health conditions (e.g., cardiovascular disease, inflammatory bowel disease, rheumatoid arthritis, diabetes), including cancer.  Some even believe mental health conditions, like anxiety, depression, and schizophrenia are also associated with chronic inflammation.

Inflammation contributors

We are at a point that researchers believe most acute and chronic diseases result from inflammation.  This means that conditions like Alzheimer’s disease, obesity, heart disease, cancer, stroke, chronic respiratory diseases, asthma, allergies, chronic kidney disease, inflammatory bowel diseases, autoimmune diseases and more are all “chronic-inflammation-related” diseases.  Some researchers go so far as to believe that once you have inflammation, there is a high probability of having another disease or condition.  In other words, when the body’s normal functioning is disrupted in one area, it places stress on the functioning of other body systems.

Even if we discount some of the more extreme views of inflammation, there is no denying that people tend to experience increased inflammation as they get older.  This is partly due to the natural impairment of gene regulation, weight gain, and other factors.

However, not everyone will experience the negative repercussions of “chronic-inflammation-related” diseases, and some who do may not experience severe consequences.  Genetics may be the most significant determinant.  Some people may be genetically predisposed to certain health problems, like cardiovascular disease, diabetes, inflammatory bowel disease, and rheumatoid arthritis.  These health problems may lurk in the background, asymptomatic, waiting for a trigger.

Can you avoid inflammation?  No.  As noted above, acute inflammation is part of the normal immune response.

Can you avoid chronic inflammation?  Probably not.  However, since chronic inflammation can lead to poor health and premature death, it makes sense to try.  Alleviating certain contributors may help:

  • stress,
  • poor diet,
  • inactivity,
  • poor sleep, and
  • body trauma and toxic exposures.
How stress, diet & sleep affect chronic pain

Stress causes an increased release of cortisol, the body’s stress hormone.  Normally, cortisol increases sugar in the blood, enhances the brain’s use of sugar, and increases the presence of immune cells for tissue healing.  It increases blood pressure and heart rate.  When cortisol is present at high levels for an extended period, the body perceives it as a threat.  Overexposure to cortisol and other stress hormones can disrupt almost all of your body processes.  Inflammatory cells become activated and it is very difficult to deactivate them.

Poor diet and inactivity contribute to excess weight gain, which is a major driving factor for chronic inflammation.  Fat releases inflammatory chemicals and reduces the production of anti-inflammatory chemicals.  The resulting inflammation drives additional weight gain.  People who gain weight in their abdomen are at increased risk for heart disease, type 2 diabetes, insulin resistance, and Alzheimer’s disease (possibly through overactivation of the immune cells in the brain).

A poor diet, especially one that includes pro-inflammatory foods (e.g., red meat; processed meat; refined carbohydrates, such as white bread and packaged snacks; fried food; and sugar-sweetened beverages) and foods that alter your microbiome, changes your blood sugar, which leads to increased inflammatory chemicals and reduced anti-inflammatory chemicals.  There are numerous studies linking diet with cardiovascular disease and risk for colorectal cancer.

Poor sleep causes the body to break down cortisol and other stress hormones more slowly.  The resulting higher levels contribute to inflammation.

Personal injury accidents and chronic inflammation

We sometimes see a similar process with our car accident and premises liability clients.  The perception of pain is typically associated with inflammation.  When pain persists for more than several weeks, it is considered chronic.  Chronic pain persists after the observable signs and symptoms of inflammation have resolved.  Instead, what we see is “neuroinflammation” – inflammation of nerve cells and tissue.  For example, people with fibromyalgia, a chronic widespread musculoskeletal pain condition, exhibit small fiber neuropathy together with chronic neuron inflammation.

Part of the problem is that unrelieved pain can cause the brain to rewire itself.  The brain creates a feedback loop from the brain down the spinal cord and back.  Because the feedback loop involves the brain and nerve cells, it can cause psychological complications such as hypochondriasis, depression, sleep disturbances, loss of appetite, and feelings of helplessness.  We previously mentioned how these things increase inflammation.  Psychological factors like depression and anxiety can intensify pain perception by triggering neuroinflammation and the feedback loop.

This all makes chronic pain difficult to treat.  Some providers strongly recommend physical therapy, injections, biofeedback, and relaxation strategies with cognitive behavioral therapy because learning different strategies can be helpful.  The goal is to break the feedback loop and eliminate neuroinflammation.

Hire a Personal Injury Lawyer

Many people with chronic pain believe there is something physically wrong with them because their brain is telling them they are in pain.  They tend to become stressed, depressed, and despondent.  This is often exacerbated by insurance companies and insurance defense lawyers accusing them of exaggerating or making it up.  In fact, insurance companies like State Farm will hire “experts” they know will say injury victims don’t have an injury to explain their pain, just so they can avoid paying for the injuries and damages caused by their insureds.

Don’t be afraid of petty insurance companies and the defense lawyers accusing you of faking it.  Instead, hire an experienced attorney to fight for you and get you the justice you deserve.

 

Reference:
Ru-Rong Ji, Andrea Nackley, Yul Huh, Niccolò Terrando, William Maixner; Neuroinflammation and Central Sensitization in Chronic and Widespread Pain. Anesthesiology 2018; 129:343–366 doi: https://doi.org/10.1097/ALN.0000000000002130
Meldrum, Marcia L.. “Pain”. Encyclopedia Britannica, 1 Feb. 2021, https://www.britannica.com/science/pain