Non-Radiographic AxSpa and Spinal Injuries
One of the hardest things to deal with when living with axial spondyloarthritis is determining the source of pain and whether to push through it or ask your doctor. This can be complicated further with spinal injuries. It can be difficult to differentiate between joint pain and disc/nerve pain.
Pain helped me get diagnosed
I have a love-hate relationship with my disc injuries, because without them I wouldn't have found my nr-AxSpA when I did. My journey with back pain began with sacroiliac joint dysfunction, but increased in severity several years later when I tore my L4-L5 disc during a college softball game. My doctors treated the disc and nerve pain, and eventually discovered cervical disc injuries.
As treatment continued, I began having new symptoms such as weakness in my legs and an increase in pain after resting. My doctor knew these symptoms could not be explained by my disc injuries and referred me to a rheumatologist, who then found my nr-AxSpA.
Disc pain and AxSpa pain
I can mostly tell the difference between my disc pain and AxSpA pain because I had one before the other. For me, the disc pain is sharper and more acute. My nr-AxSpA pain presents as an ache and stiffness. The discs typically causes nerve pain to radiate down my arms or legs, but my nr-AxSpA doesn't.
However, there are some days where the two blend together. Or worse, I have a new type of pain that I can not readily attribute to either. My typical method of determining the source of pain is to see what helps to remedy the symptoms. For example, when I have disc pain I find that traction helps to take pressure off the discs and can provide relief. However, when I have joint stiffness, I try light exercise and heat if the pain increases. When a new pain arises, I try both methods and see what works best.
The "jelly donut" lesson
Non-radiographic axial spondyloarthritis (or nr-AxSpA) comes with its own difficulties, but especially with existing disc issues. Whenever I get imaging done (typically an MRI), I always get the “jelly donut” lesson from my doctors. This is the way they explain bulging or herniated discs. The “jelly” is the inside of the disc that protrudes and causes nerve pain. My disc degeneration and cervical straightening also show up on MRIs.
With nr-AxSpA though, there are usually no signs of my AS visible on my imaging. Besides making it difficult to diagnose, this can be incredibly frustrating as a patient. I feel my AxSpA pain as much, and sometimes more, than my disc pain so why doesn’t it show up? The short answer is that with nr-AxSpA, my X-rays will not show definitive damage of my SI joint. Sometimes an MRI of the SI joint shows visible inflammation, which can help with a diagnosis along with the HLA-B27 gene.
AxSpA can often come with a litany of mystery symptoms and if there are other spinal injuries already existing, it can make pain management complicated. The good news is that some treatments help with pain for both! I find that light exercise and stretching help to prevent both my disc and joint pain. Ice helps to calm down my inflamed joints, while also chilling nerve pain caused by my injured spinal discs.
Life with nr-AxSpA and disc injuries can feel like a guessing game at times. I try to have patience and track my symptoms in a pain journal to better understand them, so I can better treat them.
Can you tell when a flare is coming?