One of the predominant manifestations of spondylitis is chronic pain in the spine. Chronic pain can decrease mobility, daily functioning of tasks, mental health and overall quality of life. Therefore, it is critical to minimize the amount of pain you experience.
Constant chronic pain can cause changes to the nervous system in some people. These changes may lead to persistent pain symptoms that can be treated differently than pain caused by inflammation. There are nerve pain medications used to help treat the nerve pathways that lead to the pain sensations some people experience. The pain that is felt is often described as sharp, burning, electric shocks, tingling or crawling like sensation under the skin.
Pharmacologic Therapy for Pain
The main treatment options for disease management include prescription medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and biologics. Your doctor can work with you to figure out which medications will fit best for you. Although pharmacologic treatment is crucial, nonpharmacologic interventions are also important in pain management. You should discuss with your physician the medications that are available in Canada and which is the best one for you.
Exercise and Physical Therapy for Pain
Exercise plays a major role in pain management in spondylitis. Majority of patients will find a benefit in symptoms when undergoing regular and proper physical activity. Postural exercises, stretching, yoga and strength training are valuable activities to consider. Preliminary training with a physical therapist is recommended to optimize safe and effective exercise routines. Other interventions such as massage and hydrotherapy may also aid in pain management. It should be noted that any interventions involving spinal manipulation should be avoided in patients with spinal fusion or severe osteoporosis.
In spondylitis, smoking is related to higher levels of disease activity. Therefore, smoking cessation is highly encouraged to lower pain levels. Smoking cessation also has other benefits such as reduced cardiovascular disease risk, decreased chronic lung disease risk and increased quality of life. If you are considering smoking cessation, it is recommended to consult with a doctor or pharmacist, as a majority of individuals have an easier time and greater success with the help of a healthcare provider.
There is an association between chronic pain and depression. Chronic pain can contribute to depression and depression can lower pain thresholds. This feedback loop should be prevented or managed to optimize pain management and mental health. Reach out to a health care provider if you think you are experiencing anxiety or depression. Joining support groups from organizations such as the Canadian Spondyloarthritis Assocation may help reduce the stress burden from your condition.
Treatment Adherence for Pain
Spondylitis is a life-long condition, meaning that treatment should be sustained life-long as well. To maintain pain control, it is essential to take medications on time to ensure that medications stay at effective levels in your body. You can set reminders on your calendar or download phone applications if you find that you sometimes forget to take your medication. It is also imperative to maintain nonpharmacologic treatments such as doing regular exercise.
Self-monitoring and communicating with healthcare providers
Tracking your symptoms regularly may help with long-term pain management. Being able to notice changes in pain levels can help you identify any factors that could be contributing to your pain. Tracking pain levels can also help you better communicate with your healthcare providers so that they can have a better understanding of your symptoms.
Simple questions that you can reflect upon by rating them on a scale from 0-10 are:
- How would you rate the overall inflammation in your joints?
- How would you rate the discomfort you feel from any tender or swollen areas?
- To what extent does pain from inflammation affect your sleep?
- To what extent does pain from inflammation affect your ability to perform daily tasks?
- Do you experience morning stiffness? If so, how long does it last?
Prepared by: Dr. Max Sun, Franklin Hu (UBC Pharmacy student)