Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the spine, causing inflammation in the joints and ligaments. While AS largely affects the spine, it can also involve other joints and organs throughout the body. Pain is a central symptom for individuals living with this condition.
Understanding the Nature of AS Pain
The pain associated with AS often presents as inflammatory back pain, characterized by a gradual onset before the age of 45. This pain commonly affects the lower back, buttocks, mid-back, or neck, and tends to worsen during periods of rest, particularly at night or after prolonged inactivity. Physical activity and exercise often provide relief from the stiffness and pain.
Beyond spinal involvement, AS pain can manifest in other areas due to enthesitis, which is inflammation where tendons or ligaments attach to bone. Common sites include the heels (such as the Achilles tendon or plantar fascia), the ribs where they meet the breastbone, and the pelvis. Individuals may also experience peripheral arthritis, involving pain and swelling in larger joints like the shoulders, hips, and knees. This inflammation contributes to the chronic nature of AS pain.
Factors Influencing Pain Severity
The intensity of AS pain can fluctuate, influenced by several factors. Physical activity often helps reduce stiffness and pain, making movement a common recommendation for managing symptoms. Prolonged rest can exacerbate stiffness and pain, leading to discomfort, especially upon waking.
Pain levels are worse in the morning and at night, sometimes disrupting sleep. Individuals with AS may experience “flare-ups,” periods of increased inflammation and pain, making movement difficult and uncomfortable. Over time, as the disease progresses, new bone formation can occur in the spine, potentially leading to fusion of vertebrae and increased stiffness, which can further impact pain levels and mobility.
Impact of AS Pain on Daily Life
The chronic pain and stiffness from AS can significantly disrupt daily life, extending beyond physical discomfort. Mobility can be severely affected, making routine activities like bending, twisting, or even simple movements such as turning the neck challenging. This can impact a person’s ability to perform everyday tasks, including household chores or self-care activities like showering.
Sleep quality is often compromised due to nocturnal pain and stiffness, leading to persistent fatigue. The physical limitations and ongoing pain can also influence work performance, social interactions, and overall mental well-being, increasing the risk of fatigue, anxiety, and depression. AS pain can reduce an individual’s quality of life.
Managing AS Pain
Managing AS pain involves a multidisciplinary approach aimed at reducing inflammation and maintaining physical function. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often a first-line treatment to help reduce pain and inflammation. For individuals whose symptoms are not adequately controlled by NSAIDs, other medical treatments such as biologics or other disease-modifying antirheumatic drugs (DMARDs) may be recommended.
Physical therapy and regular exercise are also integral to pain management in AS. Exercises focusing on maintaining spinal flexibility, strengthening core muscles, and improving posture can help reduce stiffness and pain. Low-impact activities such as swimming, cycling, and yoga are particularly beneficial, as they improve flexibility and support overall joint health. Lifestyle adjustments, including maintaining good posture while sitting or sleeping, applying heat or cold therapy, and practicing stress management techniques like meditation, can further contribute to pain relief and overall well-being.