That "inflammation exonerated" section is excellent. I think OTC NSAIDs are abused every bit as much as opiates, though not as harmful obviously. The point should be to manage your pain, not eliminate it. If I am still injured, I should know it so I don't over do it before my body has healed. Let your body do it's thing to fix the root cause - don't just bandaid it. I've known people to preemptively pop 800mg ibuprofen before a workout, to numb the pain they know is coming. Terrible idea, IMHO.
> If I am still injured, I should know it so I don't over do it before my body has healed
To address this specific point (not the rest of your comment, which I largely agree with): this is in line with the "old" bio-medical model of pain, and not up to date with the modern bio-psycho-social model of pain. In many cases, the biological insult to tissues will fully heal far in advance of pain subsidence, or conversely will heal long after pain subsidence. The point being that a pain experience is not an accurate indicator of the state of one's tissues.
So sometimes it overshoots and sometimes it undershoots, but is there a better heuristic readily usable by non medical professionals? (Sorry if this is addressed in the video; I have only read the summary)
Well, the field surrounding pain/injury is large and nuanced, so not only is that a difficult question to answer but it's also sort of the wrong question. And, firstly, I strongly recommend watching the linked video (if you have time). But I'll try my best here anyway.
Let's start with injury - what constitutes an injury? As in, how should the word "injury" be defined? This is a more complex issue than one might initially assume; not all pain is associated with an insult to tissue, not all insults lead to mechanical damage, insults that do lead to damage do not necessarily lead to pain, etc. So, mostly, injury tends to be defined as anything that leads to a reduction in function/performance in an organism. The ramifications of this definition are important, because things like a compound fracture, delayed-onset muscle soreness, and pain with no (known) underlying cause all meet the definition's criteria.
That last bit is the most important (and why I strongly recommend watching the video), because pain is not an input to the brain, rather it is an output of some function in the brain that takes a large number of inputs other than pain. This is basically the crux of the whole bio-psycho-social model, and why I said the original question is sort of the wrong question regarding injury. So here's the revelatory part, as it relates to the original question: aside from large and obvious traumas like a compound fracture, one cannot conclude that, because they are experiencing pain, physical damage to tissue has taken place. So looking for a heuristic to determine the state of some tissue after experiencing an event that led to pain is not really the right approach from the beginning, as one cannot be confident (and should not assume) that the tissue's state is awry at all.
I'm afraid I must strongly disagree with your comment, or at least your conclusion.
The existence of pain itself is predicated on its accurate coupling to injury, since the purpose of pain is inhibitory: this hurts, so stop doing it, [because tissue is injured], and it must not continue to be injured.
There are of course some counterexamples where this line of thinking fails: pain localized to previously amputated limbs comes to mind.
But overall I can think of very few instances where this is true. The magnitude of pain may or may not be proportional; the location may or may not be correct (as in referred pain); but in the vast majority of cases that can I bring to mind, pain very much does indicate tissue damage.
(And the biopsychosocial model of pain doesn't change that! The brain, after all, is tissue.)
> pain itself is predicated on its accurate coupling to injury, since the purpose of pain is inhibitory
> pain very much does indicate tissue damage
These statements are not supported by modern research. The bio-psycho-social model indicates that pain is a threat detection and deterrent mechanism, NOT a "status report" from the painful tissue to the brain. In other words, the brain is concerned that something might lead to physical trauma, yet none need to have taken place for pain to be generated.
There are certainly biological inputs to the "pain generator" function of the brain (like sensing a foreign object touching one's skin), but psychological factors/contexts and social factors/contexts can be equally strong inputs (and ultimately generate a significant pain experience without any, or with very little, biological input).
Think of the magnitude of pain response to a given situation as an indicator sitting somewhere on a spectrum between "benign" and "dangerous". The more psychologically threatened one feels, the more the pain response will be shifted toward the "dangerous" end (i.e. higher magnitude). The more socially threatened one feels, the more the pain response will be shifted toward the "dangerous" end.
Here is a somewhat contrived but favorite example of mine. One night, you wake up to go to the bathroom. In the dark, you unexpectedly step on your child's lego brick left on the floor, and it hurts immensely - it feels like the pegs are actually spikes! This is mainly because of how it has surprised you; the context is that it's dark, you expected the trip to the bathroom to be just a few simple steps, and (for sake of argument) have never stepped on a lego before. Your brain feels rather threatened by this surprising situation and generates a large pain response. Now, a night or two later, it happens again, and though it hurts it definitely isn't as bad. Another night or two later, it happens a third time, and barely hurts at all (you're basically to the point of expecting it now). I think we can agree that no tissue damage has really been done, and if pain was simply a state-of-tissue indicator then the magnitude of pain should have been the same each and every night. Additionally, if tissue damage need be present for pain to be present, why did it hurt at all?
Lastly, I'll note that lack of apparent examples != lack of evidence.
similarly, i decided to forego pain meds for my dog when she broke her tail (against recommendstion), because the vet also told me the biggest risk was further injury through activity. i felt conflicted and kept a close eye on her, but the pain told her to stay still long enough for it to heal sufficiently before being active again. i do the same for myself for any pain that isn’t excruciating.
ha, it wasn't because of wagging too fast. =) i didn't actually see it, but i think a car might have run over it. she had no other injuries so it's hard to say.
Usually I'll restrict the NSAIDs to bedtime, if the inflammation pain will keep me from getting sleep. I figure sleep deprivation is worse for the healing process than whatever problems reduced blood flow would cause.
> I think OTC NSAIDs are abused every bit as much as opiates, though not as harmful obviously
This is true only in the short term IMHO. Most people discount (or are unaware of) the severity of long term use leading to gastrointestinal issues. NSAID enteropathy is no joke...
On a slightly related note: I've never been able to get into the "start your day with a cold shower" thing, and find myself skeptical of its health benefits. I find that I need a very warm shower to massage my muscles, while a cold shower leaves them cramped and sore, reducing my ability to heal from exercise and engage in extensive physical activities through the week.
The best I've ever been able to do is a James Bond shower--wash hot and then rinse cold. The main benefits of the cold rinse seem to be psychological rather than physical: you've done something very uncomfortable, which makes you feel like a badass, and it wakes you up a little bit, too.
Very timely article, as I'm currently sitting in the doctors office waiting room to be seen for a sprained ankle.
> The resulting vasoconstriction from cooling, not only reduces tissue oxygenation with necrosis if extreme, but inhibits the inflammatory response needed to initiate healing.
Wondering if this means applying heat would speed up healing due to increased blood flow.
There's a balance. Excessive inflammation pushes joints and ligaments out of position. However, it's the way the body brings fluids to heal the injury.
Manage it, don't let it go wild, and don't try to drug/compress/ice it into oblivion and make it last longer.
Currently have my moderately sprained ankle elevated. This is the worst sprain I've had in 20 years, so taking it really easy.
For those just reading the headlines and comments: before you try this at home, please note that the paper indicates that this EXCLUDES certain types of injuries, such as fractures.
I would have been okay with RICE. After breaking 1.5 arms (well, it felt like it, just an elbow fracture), I wish I had known about RICE. Six hours later, in A+E I get a bit of fabric and some string with the 'you've broken it mate!' serenade from the X Ray department.
Two weeks after that I watch something about sports injuries and realise how much better things would have been had I just bought some ice after my bicycle crash and got myself a cab home instead of riding the ten miles or so, up and down over a big hill.
This was with the NHS and if I was running that department I would have a big bag of ice, right there on reception with a 'help yourself' sign. People wouldn't have to wait for four hours before being seen to, not that RICE was even on offer.
RICE would have been nice, maybe with an upgrade to this MOVE thing.
Sounds like you'd benefit from taking a first aid course. You can see if the Red Cross offer one near you, or your local mountain rescue or lifeguard station if you live near one of those. As well as RICE you can learn some more useful skills: treat injuries and burns, administer CPR, etc.
That said, for suspected broken bones an X-ray really is recommended. Depending on the nature of the fracture, you might need a cast instead of a sling and even the most experienced doctor can't tell you which until they've seen the X-ray results.
What athletes and coaches have known for decades, basically.
RICE is for serious things that render you incapacitated.
If you can remain active with the injury then you do so, and monitor it: if it gets better with activity, then keep with it. If it worsens, back off. Very simple.
The physically active people I know (of whom I am not one!) seem to follow this pattern compulsively anyway. They always hurt themselves being physically active and they hate not being physically active so they get back out there again.
This seems intentionally misleading. RICE is acute care immediately following an injury, to prevent further damage and relieve pain. MOVE (a terribly strained acronym) is for rehab/physical therapy. What is newsworthy here?
This is covered at length in a book titled “Good to Go.” It was such a good read and addressed so many things that I’d taken as a given about recover. Highly recommend the approach and the style of the author.
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