3 min|Dr. Maya Kuczma

Inflammation - Friend or Foe?


Many treatments for acute and chronic pain aim to fight a common ‘enemy’: inflammation.

Vilified as the potential root cause behind cardiovascular disease, cancer, diabetes, and depression, many treatments have emerged targeting all inflammatory triggers. And for good reason – chronic, out of control inflammation has been shown to damage the lining of blood vessels, skin, joints and a variety of other structures in our body. But as a result, “inflammation” has become a buzzword that just won’t quit, and the overwhelming message is that all inflammation is bad.

It’s Not All Bad…

When the body is injured, the immune system mounts a response to try to manage the damage. Substances called prostaglandins are released, causing the blood vessels in the area to dilate. This allows neutrophils reach the wound and ‘clean up’ the area while platelets clot the wound site. It also allows for macrophages, another immune cell, to rush the area and release growth factors that help to heal the injured tissues.This response is crucial to the healing process. However, much of the advice we hear regarding treating injuries aims to quell the inflammation necessary for healing.

Non-steroidal anti-inflammatory drugs (NSAIDS) halt the release of prostaglandins, diminishing the body’s ability to bring in cells required for healing the area of injury. Additionally, they inhibit the synthesis of proteoglycans, a substance required to repair the connective tissue of our ligaments and tendons.

Another commonly prescribed treatment of acute injuries known as RICE (rest, ice, compression, elevation) aims to decrease inflammation, effectively halting the healing process. Even Dr. Gabe Mirkin, the inventor of the RICE prescription, has called into question the efficacy of this treatment stating that “it now appears that both ice and complete rest may delay healing, instead of helping”1.

Ice decreases blood flow the area, disabling the transport of required immune cells into the damaged tissue. It also decreases the release of growth factors required for healing. Tissues that already have low blood supply, such as ligaments, are particularly effected by this further decrease in blood flow. Ligament injuries that have failed to heal completely are often the root cause of chronic pain in many joints, including the ankles, knees, low back, neck and shoulders. Additionally, ligament injuries are commonly the injuries that take athletes out of the game.

Now What?

If chronic systemic inflammation can be harmful, but acute inflammation is required for healing, how do we harness the forces of inflammation for good rather than evil? This is the aim of Regenerative Injection Therapies (RIT) such as prolotherapy and platelet-rich plasma injections. Prolotherapy, derived from the word ‘proliferation’ (aka new growth), uses targeted injections into the site of damaged tissue in order to create a localized inflammatory response and promote healing. A solution of dextrose (sugar) as well as an anesthetic is injected into the injured tissue, triggering increase blood flow and the influx of platelets, immune cells, and growth factors.

In cases of more severe damage, Platelet-Rich-Plasma (PRP) may be used. PRP harnesses the power of your own platelets, taken from a blood sample you provide, to trigger a healing response. Instead of causing inflammation to trigger an influx of platelets, we inject the platelets directly into the injured tissue, effectively bypassing many steps of the inflammation cascade. Prolotherapy and PRP aim to create a natural inflammatory response in order to heal injured tissue and resolve pain.

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