Identifying and Treating Inflammation
By Paul J. Millea, M.D. - U.S. News & World Report
There are three types of inflammation: acute, chronic and life-threatening.
When basketball star Steph Curry slipped and injured his knee in late April, he reacted by tearing up on the sideline, while fans and media reacted by wondering how many games he would miss. His body? It reacted by inflaming around the outside of the knee, protecting the area as it recovered from a medial collateral ligament sprain.
The word inflammation can conjure up visuals of a swollen, red and throbbing knee or, thanks to some TV ads, a lit match doused by a medicated pad. Conventional public wisdom frames inflammation as being adverse, painful and harmful – something most people want to resolve quickly with medication.
Inflammation, however, plays vital roles in our bodies, making our immune systems more responsive and attracting nourishing fluids to injuries. Without inflammation, we would succumb rapidly to infection, be unable to heal from surgeries and injuries and develop diseases more frequently. Simply put, without inflammation, we would not survive.
Medical professionals have known the truth about inflammation for quite some time. Ancient Greek physicians recognized it as a fundamental aspect of human illness with four distinguishing features: pain, redness, swelling and warmth. The ancient Roman physician Galen noted that inflammation is also often marked by the affected tissue's loss of function.
Inflammation manifests itself in three main types: acute, chronic and life-threatening. It's important to understand the differences between the three, how to identify them and how to treat them.
During the acute phase, immediate pain from the injury is accompanied by swelling, redness and warmth.
The damaged cells release chemicals that stop bleeding and cause the blood to clot. These chemicals also sequester the damaged or infected tissue, and attract blood cells to sterilize and/or remove the damaged structures. As healing ensues, replacement tissue or a scar grows, and the swelling, redness and warmth disappear.
The body's response to a knee or ankle sprain, like Steph Curry had, includes acute inflammation.
Treat acute inflammation by managing it, not trying to cure it. For the first 24 to 48 hours, follow the acronym RICE: Rest, Ice, Compression and Elevation. You can take limited doses of a painkiller like ibuprofen, but do not exceed the recommended dose. Keep in mind that swelling and the pain you feel is designed to immobilize you so the injury can get the body's nourishing fluids to heal. Taking high doses of painkillers and other anti-inflammatories may actually prevent that nourishment and healing, leading to persistent pain and instability.
As the pain decreases, don't rush back to normal activity, but rather gradually increase motion and use of the affected part. To treat a sprained ankle, for example, I often recommend patients gently move the ankle by placing their feet on a towel and tracing each letter of the alphabet on the floor.
I also tell my patients to email me a picture of the swelling if they need some advice. If the pain and swelling have not substantially declined within 72 hours after sustaining the injury, or if you don't recover fully within three to four weeks, see your primary care doctor. You may need a stronger medical intervention to heal the injury.
Chronic inflammation has not been defined precisely in medicine, but it typically refers to inflammation that lasts longer than six months. The damage or infection is ongoing, causing continuous inflammation that can slowly close down and injure blood vessels, nerves and organs like the kidney – as well as joints, skin and even the brain. But you may not feel any pain, because many organs do not have pain receptors.
Chronic inflammation can spark major disorders including coronary artery disease, hypertension and stroke – and even brain diseases such as depression, Alzheimer's and Parkinson's. If you have hypertension, high cholesterol, diabetes or obesity, you likely are afflicted by a high level of chronic inflammation.
Although the medical community doesn't entirely understand chronic inflammation, we have identified frequent causes. These include having a sedentary lifestyle or persistent stress and insomnia, as well as smoking or exposure to environmental toxins. Conditions such as bone infection and gum disease, as well as dietary factors, also cause chronic inflammation.
You are best served by working with your doctor to manage your blood pressure, cholesterol, blood sugar and weight. Strive to get 30 minutes of daily exercise, lower your stress and get more regular, uninterrupted sleep. Consider making dietary changes as well. Foods such as many vegetables and fruits, fatty fish and other seafood can decrease chronic inflammation. In contrast, excess refined sugar, the trans fats and other manufactured ingredients found in processed foods, and excess fat may increase it.
When the body activates significantly more immune cells than it needs to overcome a new infection or damage that has widely disseminated throughout the blood stream, inflammation can overwhelm the affected site. This sometimes causes massive injury and even death.
During the Spanish flu epidemic of 1918 to 1920, for example, most victims were healthy young adults whose immune systems responded with exceptional vigor to the virus; inflammation impaired their bodies so severely that they essentially drowned themselves. Sepsis is another example of this reaction, called a "cytokine storm."
Recognizing the potential presence of infections that can cause life-threatening inflammation helps prevent it, and also helps prevent serious injury or death. Health care providers often use blood-testing to recognize a possible life-threatening inflammatory response early in patients.
You can also recognize if you may be suffering from life-threatening inflammation. If you're taking medication that can suppress your immune system as a side effect, or to treat rheumatoid arthritis, you are more at risk. The same goes for people who have inflammatory bowel disease, are undergoing chemotherapy or had surgery within the last six weeks. In these cases, seek medical attention immediately if your temperature exceeds 100.4 degrees Fahrenheit, or if you feel dizzy or experience a rapid heartbeat.
When caught early, doctors can overcome the life-threatening inflammation by treating the infection itself.
Fortunately for Curry, like most of us, he did not succumb to his inflammation. In a performance a Greek God or Roman gladiator could appreciate, the Golden State Warriors guard followed doctors' orders to treat his acute inflammation, missed two weeks of action and scored 40 points in his return. The tears and public discussion subsided, as did his inflammation.