Inflammatory Pain: The Role of Inflammation in Pain

What is inflammatory pain?

Inflammatory pain is pain caused in part by tissue inflammation. Inflammation is a defensive response that can follow an injury, an infection, or certain diseases. It can activate nerve endings and make them more ^{sensitive.¹, ²} These nerve endings, called nociceptors, react to situations that can damage tissue. Our physical therapy guide for inflammatory pain explains the treatment process.

Les messages nerveux ne sont pas la douleur elle-même. La douleur est une expérience personnelle à laquelle participent le cerveau, l’état des tissus, les émotions et le contexte³. Une inflammation peut donc contribuer à la douleur sans expliquer à elle seule son intensité.

This distinction helps in choosing the right treatment: addressing the cause of the inflammation when necessary, relieving symptoms, and resuming appropriate activities.

Why does your body need inflammation to heal?

L’inflammation contribue à la guérison en attirant les cellules qui éliminent les débris et participent à la réparation des tissus⁴. L’arrivée de sang et le passage de liquide hors des petits vaisseaux expliquent la rougeur, la chaleur et le gonflement⁵. Le gonflement peut limiter les mouvements; cela ne signifie pas qu’il constitue une immobilisation nécessaire à la guérison. Les substances inflammatoires rendent aussi certaines terminaisons nerveuses plus réactives^{2, 1}.

Why Your Body Causes Inflammation

Inflammation is a defensive response. After an injury, the immune system—the collection of cells and reactions that defend the body—triggers several changes:

• Increased blood flow to the area (resulting in redness and warmth)
• Release of chemicals that attract repair cells
• Swelling caused by a buildup of fluid, which can limit movement
• Nerve Sensitivity: Some nerve endings respond more readily

These reactions are part of the body's tissue repair process.

The classic signs of inflammation

La médecine décrit cinq signes classiques de l’inflammation. Ils ne sont pas toujours tous visibles, surtout lorsque l’inflammation se situe en profondeur⁵ :

• Flushing (redness), caused by increased blood flow
• Calor (heat), also caused by blood flow
• Tumor (swelling) caused by fluid buildup
• Dolor (pain), because the area becomes much more sensitive
• Functio laesa (loss of function), limited range of motion

Why does a sore spot hurt more?

An inflamed area may hurt more because inflammatory substances make certain nerve endings more sensitive. Movement or pressure can then trigger more nerve signals ². The brain and spinal cord, which transmit and process signals in the spinal column, also play a role in this sensitivity ¹. However, pain does not depend solely on the number of signals received.

An awareness-raising initiative

La sensibilisation signifie que les terminaisons nerveuses réagissent plus facilement. L’inflammation peut contribuer à ce changement¹. Elle peut aussi déclencher leur activité. Cela ne transforme pas chaque message nerveux en douleur ressentie³.

Chemical substances such as prostaglandins and cytokines are released in the affected area. The substances released during inflammation can make nerve endings more reactive ². You may then notice:

• Even light pressure that wouldn't normally hurt becomes painful
• The movements are more uncomfortable
• The area remains tender even at rest

Swelling and Movement

Le gonflement correspond à une accumulation de liquide. Avec la douleur, il peut limiter les mouvements⁵. Dans le canal carpien, un passage étroit du poignet, des tendons enflammés peuvent exercer une pression sur le nerf médian. Ce nerf participe à la sensibilité et aux mouvements de la main⁶. Cette possibilité n’explique pas tous les gonflements ni toutes les douleurs.

L’importance du gonflement ne suffit pas à mesurer la douleur ni à décider du traitement. Une zone très gonflée ou qui devient plus douloureuse après une blessure doit être évaluée⁷.

When should you request a quick assessment?

Une articulation douloureuse, chaude et gonflée demande un avis médical urgent. Il en va de même si la douleur s’accompagne de fièvre, de frissons ou d’un malaise. Une impossibilité de marcher ou de prendre appui, ou une articulation déplacée, demande une évaluation à l’urgence même sans blessure récente. Après une blessure, une douleur très forte, des picotements ou une perte de sensibilité autour de l’articulation demandent aussi une évaluation à l’urgence⁸. Composez le 911 si la vie semble en danger ou si le transport n’est pas sécuritaire. Ces signes ne doivent pas être traités comme une simple poussée à gérer par les exercices.

Consult a physiotherapist if your inflammatory pain persists for more than two weeks, if it limits your daily activities, after an arthritis diagnosis, or if flare-ups become more frequent or intense despite self-medication.

What is the difference between acute inflammation and chronic inflammation?

L’inflammation aiguë commence rapidement après une blessure ou une infection et dure généralement peu de temps, alors que l’inflammation chronique persiste pendant des mois ou des années⁹. La phase aiguë participe à la réparation; une inflammation excessive ou persistante peut aussi endommager les tissus¹⁰. La durée de l’inflammation et celle de la guérison ne sont pas identiques. Par exemple, une petite plaie cutanée peut guérir en quelques jours, tandis qu’une lésion cutanée importante demande plusieurs semaines¹¹. Ces délais décrivent la peau et ne donnent pas un calendrier pour toutes les blessures.

Acute inflammation: a rapid and temporary response

After an injury, acute inflammation:

• It begins suddenly and usually lasts a few days, depending on the cause
• An integral part of the healing process
• Fades naturally as the tissue heals

• Entorse de cheville récente
• Whiplash injury following an accident
• A tendon that has become painful following increased physical activity, possibly accompanied by inflammation. A tendon connects a muscle to a bone.

Chronic Inflammation: A Persistent Response

Sometimes, inflammation persists beyond its useful role:

• It can develop into a chronic inflammation: mild enough that it doesn't look or feel like a recent injury, but it doesn't go away completely
• It can continue to stimulate the nervous system ¹
• It may contribute to chronic pain

• Osteoarthritis (with variable inflammatory component)
• Rheumatoid arthritis: the immune system attacks joint tissue
• Ankylosing spondylitis (an inflammatory disease of the spine)
• Certain chronic tendinopathies, persistent tendon problems
• Inflammatory bowel diseases

Adipose tissue, which stores fat, also produces substances that play a role in immune responses. In obesity, these responses can contribute to mild, persistent inflammation ¹². However, a person’s weight alone is not a reliable indicator of inflammation or pain. The discussion takes into account health, goals, and preferences.

Chronic stress can contribute to persistent inflammation, along with other factors such as certain diseases or living conditions ¹⁰. Taking breaks, practicing breathing exercises, and engaging in appropriate physical activity can help manage stress. These measures complement medical care without placing the blame for the illness on the individual.

What are some common conditions associated with inflammatory pain?

Osteoarthritis, tendinopathies, and conditions such as rheumatoid arthritis can be accompanied by pain caused in part by inflammation. The extent to which inflammation contributes to the pain varies depending on the condition and the individual.

Osteoarthritis

Osteoarthritis affects several tissues in the joint, including the cartilage that covers the bone surfaces. It may be accompanied by mild, persistent inflammation ¹³. Imaging findings do not fully reflect the symptoms: the changes visible on X-rays do not always correspond to the severity of the pain ¹⁴. This discrepancy has also been described in osteoarthritis of the hands ¹⁵. Physical therapy aims to reduce pain and make daily activities easier, without guaranteeing that symptoms will disappear completely.

Osteoarthritis can affect various areas of the body, including the lower back (lumbar osteoarthritis) and the neck (cervical osteoarthritis). The link between inflammation and pain has been studied in particular in the knee. A review of 37 studies found weak to moderate associations between certain measures of inflammation and pain. The results vary depending on the measure used, such as imaging or blood tests ¹⁶. They do not allow us to infer the intensity of pain based on a single sign of inflammation.

Tendinopathies

Tendinopathy is a tendon condition that can cause pain and limit physical activity. Inflammatory cells and substances may be present even when the condition persists ¹⁷. Thus, inflammation may coexist with physical activity that exceeds one’s current capacity. “Tendinitis” refers to inflammation of the tendon; “tendinopathy” describes the condition without assuming a single underlying mechanism.

For tendinopathy, exercises with gradually increasing intensity are part of standard treatment ¹⁷. The 2019 review recommends this progression rather than complete rest ¹⁸. The program depends on the affected tendon and the target activities.

For patellar tendinopathy, which occurs beneath the kneecap, strengthening exercises are commonly used. Eccentric strengthening involves slowing down a movement as the muscle lengthens, such as by bending the knees to lower oneself into a chair. The 2025 Cochrane review examined seven trials involving 211 athletes. One trial involving 39 athletes found less pain with exercises than with no treatment, but the authors consider this result to be highly uncertain. Differences in performance were also unclear. The studies also make it difficult to determine which is more effective: exercises, injections, or surgery ¹⁹. These limitations pertain to this specific comparison and this population; they do not represent the full scope of physical therapy care.

Bursitis

Bursae are small fluid-filled sacs that reduce friction between different parts of the body. When they become inflamed (bursitis), they cause pain and limit movement. Common locations include the shoulder (shoulder bursitis), hip, and knee.

Autoimmune diseases

In rheumatoid arthritis, the immune system attacks joint tissue and causes ongoing inflammation. Medical treatment may be necessary to manage the disease and protect the joints. Exercise and advice complement this care; they are not a substitute for prescribed treatment.

How can you manage inflammatory pain on a daily basis?

Managing inflammatory pain involves treating its cause, providing appropriate protection after an injury, and gradually resuming activities. During the acute phase, the type of protection required depends on the injury: a fracture may require immobilization. In the longer term, exercise, sleep, diet, and stress management support overall health and can complement medical care.

During the acute phase

After an injury, relative rest involves temporarily limiting movements that worsen symptoms while continuing permitted activities. The lateral ligaments of the ankle are bands of tissue that connect the bones on the outer side. After a sprain of these ligaments, brief immobilization can relieve pain and swelling. The 2018 guidelines then recommend a support strap or splint—a device worn around the ankle—along with exercises ²⁰. The choice depends on the severity and the diagnosis.

After an ankle sprain, a supervised exercise program helps restore joint stability during activities. The guide recommends this over passive treatments, in which the person does not actively participate ²⁰.

Ice peut apporter un soulagement temporaire, mais elle ne garantit pas une guérison plus rapide. Une revue de 2008 avait trouvé seulement six essais humains et des preuves insuffisantes sur la récupération après une blessure²¹. Une revue critique de 2024 confirme que les effets sur la réparation des tissus chez l’humain demeurent incertains²².

Nonsteroidal anti-inflammatory drugs, or NSAIDs, include ibuprofen and naproxen. They are different from cortisone-based medications. They can reduce pain and swelling, but they carry risks ²⁰. A pharmacist or doctor can check whether the product is appropriate for your health and your other medications.

Les résultats sur la guérison des fractures sont nuancés. Une synthèse de 2019 associait l’utilisation des AINS à davantage de retards de guérison ou de fractures dont les fragments d’os ne se réunissent pas solidement, sans différence claire chez les enfants ni pour les faibles doses ou les courtes durées²³. Une revue de 2024 ne trouvait pas de différence nette après prise en compte d’autres facteurs²⁴. Celle de 2026 retrouve une association avec l’absence de réunion solide des fragments d’os, surtout chez l’adulte et lors d’expositions plus importantes. La qualité des revues incluses est toutefois faible. Les usages de 14 jours ou moins n’étaient pas associés à une hausse de ce risque²⁵.

After a fracture, the choice of medication, dosage, and duration of treatment should be discussed with the medical team. Do not stop a prescribed treatment based solely on these results.

In the medium and long term

A Mediterranean-style diet emphasizes, in particular, vegetables, fish, nuts, and olive oil. A systematic review found beneficial effects or associations with certain inflammatory markers—substances measured in the blood ²⁶. The findings primarily apply to adults with at least one chronic condition. The review does not demonstrate that this diet alone relieves inflammatory pain. A nutritionist can help you adjust your diet.

Sleep and inflammation can influence each other in both directions. The cited review describes, in particular, links between sleep and interleukin-6, a substance involved in communication between immune cells ²⁷. Maintaining a regular sleep schedule and seeking evaluation for persistent insomnia can support sleep. A better night’s sleep does not guarantee a measurable reduction in inflammation or pain.

How does physical therapy help with inflammation?

Physical therapy helps manage symptoms and resume activities during or after an inflammatory condition. The physical therapist assesses movement and difficulties, tailors exercises, and looks for signs that require medical attention. This assessment alone does not measure the full extent of inflammation in the body.

What physical therapy can do

Les mobilisations articulaires sont des mouvements appliqués par le professionnel à une articulation. Certaines personnes peuvent ressentir un Short-term relief. Une revue de 2016 sur les mobilisations de la colonne décrit une diminution de sensibilité à la douleur et certains changements musculaires²⁸. Une revue de 2023 trouve toutefois peu de preuves d’un effet immédiat constant sur la pression nécessaire pour provoquer une douleur, face à un traitement simulé ou à l’absence d’intervention²⁹.

These sensitivity tests do not indicate an anti-inflammatory effect. Manual therapy may be used as a complementary treatment depending on its effect on your symptoms; exercises and a return to normal activities should be tailored to the specific condition being treated.

To learn how a physical therapist actually treats this type of pain, check out our guide on physical therapy for inflammatory pain.

What should you do when inflammation isn't the whole story?

Pain that cannot be fully explained by inflammation requires an evaluation of other possible mechanisms, activities, and life circumstances. For example, nerve damage or increased sensitivity of the nervous system may contribute to the symptoms. Several mechanisms may coexist.

Other types of pain

La douleur neuropathique est liée à une lésion ou à une maladie du système nerveux qui transmet les sensations. La douleur nociplastique implique une modification du traitement des messages corporels, sans qu’une lésion des tissus ou du système nerveux explique suffisamment la douleur³. Ces mécanismes peuvent se combiner et orienter les soins^{1, 30}.

Mixed pain

Several mechanisms can contribute to the same pain. Your back pain or neck pain may involve inflammation, pain associated with certain activities, and increased sensitivity of the nervous system. The examination helps determine the appropriate treatment without assuming that a single mechanism explains everything.

Chronic pain management may take into account tissues, the nervous system, sleep, emotions, and activities. The cited review describes a personalized approach to care, involving multiple professionals when appropriate ³⁰. The plan may therefore combine medical treatment, exercise, and support for daily challenges. Interventions are selected based on individual needs, without assuming that a single combination is suitable for everyone.

What are the key points to remember about inflammatory pain?

Inflammation helps with tissue repair and can also contribute to pain; treatment should address the underlying cause and support your daily activities. Rest after an injury, appropriate exercises, and medical treatments all have their place, depending on the situation.

• Inflammation is a healing process; it is beneficial during the acute phase
• Inflammation can contribute to pain by activating certain nerve endings or making them more sensitive
• Chronic inflammation can contribute to persistent pain and requires a long-term approach
• Exercise, diet, sleep, and stress management can support health and complement treatments, with varying effects
• A tailored plan takes into account pain mechanisms, your activities, and the treatments required for the condition

Where can I read more about pain and its mechanisms?

Physioactif's guides on chronic pain, neural mechanisms, and pain management explain these topics in detail. The following list will help you choose a resource based on your questions.

• Comprendre la Chronic pain
• Acute pain vs chronique
• Douleur neuropathique
• Douleur nociplastique
• Stratégies de gestion de la douleur
• Revenir à la définition de la douleur inflammatoire

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