Chronic Back Pain
Symptoms of spondyloarthritis (SpA) can vary, depending on the kind of SpA you have and where your condition falls along the SpA spectrum. One of the main symptoms of SpA is chronic inflammatory back pain. This is different than the general back pain you might have after overextending yourself or regular activity.
What is chronic inflammatory back pain?
Inflammatory back pain is back pain that is local to the axial spine and sacroiliac (SI) joints and is very different than mechanical, or “regular” back pain. It is often associated with other inflammatory conditions.1 In inflammatory back pain, the pain is usually in the lumbar spine, or lower spine, and may be in the buttocks, alternating sides.1 There are several differences between mechanical and inflammatory back pain. Mechanical pain is more acute and worse with activity and at the end of the day. Inflammatory back pain tends to come on slower and be more of a stiffness that feels better after moving around and “loosening up” and worse in the mornings.
To diagnose inflammatory back pain as opposed to mechanical back pain, the following characteristics are examined:2
- Onset of pain typically under the age of 35 and typically gradual
- Pain lasts more than three months (makes it chronic)
- Back pain and stiffness worsen with being sedentary and are especially bad in the morning
- Back pain or stiffness improve with exercise
- Non-steroidal anti-inflammatory medications (NSAIDs) are effective for many people
Among those in the US, approximately 5 to 6 percent of adults ages 20 to 69 live with inflammatory back pain.1
Why does chronic inflammatory back pain occurs?
The inflammation with SpA causes the inflammatory back pain. The inflammation also leads to stiffness of the back, making it difficult or painful to bend or move. Many genes have been associated with SpA that may cause this inflammation – at least 30 genes have been found.3 The main gene associated with SpA is HLA-B27, a gene linked to immune response.3
Even with genetic components, there is no one cause of SpA or its symptoms. It is likely a combination of genetic, environmental, and lifestyle factors that can impact the level of inflammatory back pain.
Treatment for AxSpa
Treating the chronic inflammatory back pain associated with SpA can vary, depending on the kind of SpA you have and how severe your symptoms are. You might use a variety of treatments, especially a combination of drug and non-drug treatments, in order to manage your inflammatory back pain.
Prior to any treatments, learning about your inflammatory back pain and your SpA may be helpful in learning what to expect, how it may progress, and things you can do to help minimize the symptoms. If you smoke, ask your doctor about supports to help you quit, since this can make symptoms worse.1
Treatment and alternative therapies
Treatments can include:2,3
- Physical therapy and joint-directed exercises, as well as exercise that encourages spinal extension and mobility
- Non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line of treatment, including naproxen, ibuprofen, meloxicam, or indomethacin
- Corticosteroid injections may relieve localized joint swelling
- Disease modifying antirheumatic drugs (DMARDs) like sulfasalazine can relief symptoms and may prevent further joint damage, and can be especially helpful for people who also have symptoms in their arms and legs
- Biologics are often used for people who have inflammation in the spine, often seen in ankylosing spondylitis (AS); these include TNF-inhibitors and IL-17A inhibitors, which are also used in SpA
As with any medication, these drugs may cause side effects for some people. Some may not be as effective as others for people. Talking with your doctor about any side effects or the effectiveness of a medication is important in finding the right treatment for you. If one isn’t right for you at the given time, another one might be better. Finding the right treatment can help you manage your inflammatory back pain and minimize associated symptoms so you can maintain your quality of life.