Is Your Pain From an Injury or Inflammation?

Common Types of Inflammation and Their Effects On Pain

Commonly, a fair amount of our patients enter the clinic experiencing pain with no clear mechanism as to how the pain started in that there was no specific moment of trauma. There was no fall or movement that created the pain. It just built slowly over time. While the vast majority of our patients respond well to exercise and addressing movement patterns, occasionally they will not respond as expected. This leads us to start asking ourselves and the patient “What other factors can be contributing to your experience of pain?” as a means to get a more holistic perspective on the matter. Inflammation levels and inflammatory hyperactivity are frequently and adjacently potentially responsible for increasing our experience of pain.

To start understanding how inflammation can lead to pain, we first need to understand, in general, what inflammation is. Inflammation is a medical term used to categorize a division of immune response reactions that occur in the body. These reactions can be triggered by a foreign pathogen such as a bacteria or virus invading our body, an acute injury to bodily tissue, and sometimes from ingesting certain foods. Inflammation works in the body to create chemical reactions that lead to increased blood flow (which leads to redness), increased temperature/fever (which is a result of increased blood flow but also helps to destroy the foreign pathogen), increased swelling (due to increased lymphatic activity in the area of inflammation), and increased pain (resulting from chemical changes in the area as well as mechanical strain from swelling).

Normally, inflammation within the body or within a site of injury is justified and will help to promote the healing process. Increased blood flow will help to deliver nutrients to the cells that are regenerating and export byproducts of damaged cells. Increased body temperatures will help in making the environment less hospitable for foreign pathogens and also may help to promote freedom of movement in the underlying tissues. Increased swelling will help to bring White blood cells into the involved area which will help to flush out damaged cells/pathogens. Pain is experienced when the nerves in the inflamed area sense the chemical changes resulting from increased amounts of inflammatory mediators such as bradykinin and histamine. Mechanical stretching of the tissue in the site of an injury for instance will lead to pain as a result of increasing the pressure around the nerves. While inflammatory pain is not a pleasant experience, normally this means that the body is doing its job to heal a wound or protect the body.

Where inflammation becomes a problem is when the inflammatory response supersedes the pathogen/tissue injury or when the inflammatory response is being triggered when there is no justification for it. Because inflammation partly activates to make the environment inhospitable for a potential pathogen, if the inflammation gets out of hand it can also start to damage our own cells. Aside from the tissue damage that can occur, higher levels of inflammation also correlate with higher levels of pain. Sometimes, the immune system can mistakenly target the cells of our own body.

This is called an autoimmune response/disease. Autoimmune diseases such as Rheumatoid arthritis, Psoriatic arthritis, Crohn’s disease, and Lupus are all commonly associated with increased intensity and frequency of joint pain. This, however, is the vast minority of people experiencing pain. Most inflammatory related pain is much more mild and related to food intolerances, lack of adequate sleep, excessive alcohol intake, smoking, stress, and other lifestyle factors. Inflammatory pain related to these factors also tends to respond well to conservative intervention.

Symptoms of inflammation such as swelling, redness, pain, and movement restriction can be treated in the clinic. While not performed often, in the midst of an acute injury we can use ice to reduce swelling, transiently reduce blood flow via vasoconstriction caused by cooling the area, and desensitization of nerve signaling so that rehab exercises can be performed more comfortably. Kinesio Tape can also be applied with a lymphatic drainage technique to help increase the mobility of lymph fluid in an inflamed region of the body. For more chronic type inflammation, reestablishing adequate range of motion and performing exercise can help to promote a more normal inflammatory response in the body.

When more conservative interventions do not work as expected however, obtaining more information is essential. The best place to start when gathering information about the inflammatory state in the body is to look at biomarkers that represent inflammation levels in the body. Data from blood tests like CBC, ESR, C-reactive protein, HLA-B27, rheumatoid factor, HbA1c, ApoB, LDL-C/Lipid Panel and a Chemical Panel can also be ordered so that we can rule in/rule out the potential inflammatory underpinnings that may be causing your symptoms.

For most of our patients, addressing the underlying lifestyle factors that could be contributing to inflammatory based pain are usually made a secondary priority to addressing the biomechanical contributions to pain. This is because the majority of musculoskeletal pain that patients experience is directly related to how they move, how their nervous system and mind interprets their experience of pain, and their overall physical capacity relative to their daily physical demands. When patients do not respond as expected to our movement based medical approach however, we need to start a discussion about what the next steps are so that they can receive the symptoms relief they deserve.