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How To Treat Inflammatory Back Pain

Signs And Symptoms Of Inflammatory Back Pain

Know your pain: 3. Inflammatory pain
  • Chronic back pain that lasts for 3 months or more
  • Pain develops before age 40
  • Condition develops slowly
  • Early morning pain and stiffness lasting over 30 minutes
  • Exercise and moving the affected joints reduces pain
  • Pain reduces with hot showers
  • Pain worsens in the evening or with rest
  • Tenderness in the SI joint, often seen as alternating buttock pain

How Is Inflammatory Back Pain Diagnosed Or Evaluated

If you are experiencing chronic back pain, you should speak to your family physician, nurse practitioner or primary care provider. Your primary care provider will mostly likely take your medical history and conduct a physical examination. So, it is important that you carefully answer questions regarding your symptoms. Your primary care provider may also refer you to a rheumatologist. A rheumatologist is an internal medicine specialist physician who specializes in diagnosing and treating inflammatory conditions involving bones, muscles, and joints.

Depending on your medical history and the results of your physical examination, your primary care provider or rheumatologist may order additional tests, such as blood tests or imaging. Imaging may include X-Rays, magnetic resonance imaging scans, CT scans, bone scans, and other tests. The presence of the HLA-B27 genetic marker on a blood test can indicate that your back pain is ankylosing spondylitis. Imaging that shows inflammation in the SI joint can indicate inflammatory back pain.

Knowing The Difference Will Dramatically Affect Your Back Pain Treatment

This video is part of a new campaign about ankylosing spondylitis awareness from the nonprofit patient community CreakyJoints. The videos in this campaign were produced with support from Novartis Pharmaceuticals Corporation.

If your back has been bothering you, you might chalk up your pain to a bad mattress, overdoing it at the gym, or throwing out your back while lifting something heavy. All of these are considered mechanical causes of back pain, which means that theres been a disruption in the way the components of the back fit together and move, according to the National Institute of Neurological Disorders and Stroke.

However, theres another and much less well-known kind of back pain that is considered to be inflammatory back pain, not mechanical.

This kind of back pain, which is a form of inflammatory arthritis, occurs because your immune system is mistakenly attacking the joints in your spine. This back pain is known as ankylosing spondylitis or axial spondyloarthritis.

Ankylosing spondylitis typically affects the bones in your lower spine and where your spine connects with your pelvis . Theres also inflammation where ligaments and tendons attach to bone, such as the Achilles tendon at the ankle. The most common AS symptoms are on-and-off flares of pain and stiffness in the lower back, hips, and buttocks.

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Laser Therapy For Inflammation In Delaware

At Delaware Back Pain & Sports Rehabilitation Centers, we are equipped with the technology for deep tissue laser therapy. If you are feeling acute or chronic pain, consult with our providers to learn if this treatment method is right for you. We can help you by designing an individualized program to best suit your needs and facilitate healing.

Facts You Should Know About Ankylosing Spondylitis

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  • Ankylosing spondylitis is a form of arthritis featuring chronic inflammation of the spine and the sacroiliac joints .
  • Ankylosing spondylitis belongs to a group of arthritis conditions that tend to cause chronic inflammation of the spine .
  • Ankylosing spondylitis affects males two to three times more commonly than females.
  • Ankylosing spondylitis is a cause of back pain in adolescents and young adults.
  • The tendency to develop ankylosing spondylitis is genetically inherited.
  • The HLA-B27 gene can be detected in the blood of most patients with ankylosing spondylitis.
  • Ankylosing spondylitis can also affect the eyes, heart, lungs, and occasionally the kidneys.
  • The optimal treatment of ankylosing spondylitis involves medications that reduce inflammation or suppress immunity, physical therapy, and exercise.

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Other Types Of Diagnosis

  • A chiropractor will diagnose through touch, or palpation, and a visual examination. Chiropractic is known as a direct approach, with a strong focus on adjusting the spinal joints. A chiropractor may also want to see the results of imaging scans and any blood and urine tests.
  • An osteopath also diagnoses through palpation and visual inspection. Osteopathy involves slow and rhythmic stretching, known as mobilization, pressure or indirect techniques, and manipulation of joints and muscles.
  • A physical therapist focuses on diagnosing problems in the joints and soft tissues of the body.

What Is Inflammatory Back Pain

Inflammatory back pain is a chronic condition that occurs when inflammation or swelling starts to occur in the spine. It is often attributed to arthritis.

IBP often occurs around the lumbar spine, or the lower back, but can really appear anywhere in the spine that contains a large joint. Because spinal inflammation is often a form of arthritis it usually includes the swelling and tenderness of one or more of your joints.

Inflammatory back pain affects 3% of adults and it can occur for a number of reasons.

A number of symptoms indicate IBP:

  • The pain starts before age 40.
  • The pain lasts more than three months
  • The pain is bad enough to wake you up from a sound sleep.
  • The pain is worse in the later part of the night or early morning.
  • You feel stiff when you wake up.
  • The pain lessens with exercise and movement.
  • The pain is helped by nonsteroidal inflammatory drugs like ibuprofen.

Another possible symptom of inflammatory back pain is pain or tenderness where your lower spine meets your pelvis . You may experience this pain alternating between the buttocks. If pain spreads from there to other points of the body, that may also be a sign of inflammatory back pain.

It is not caused by any physical trauma. For most people who suffer from inflammatory back pain, it starts before age 35 and lasts for longer than three months. It’s not known why some people get this condition and others dont, but researchers believe there may be a link with a particular gene known as HLA-B27.

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What Are The Symptoms Of Lower Back Pain

Symptoms of lower back pain can come on suddenly or appear gradually. Sometimes, pain occurs after a specific event, such as bending to pick something up. Other times, you may not know what caused the pain.

Pain may be sharp or dull and achy, and it may radiate to your bottom or down the back of your legs . If you strain your back during an activity, you may hear a pop when it happened. Pain is often worse in certain positions and gets better when you lie down.

Other symptoms of lower back pain include:

  • Stiffness: It may be tough to move or straighten your back. Getting up from a seated position may take a while, and you might feel like you need to walk or stretch to loosen up. You may notice decreased range of motion.
  • Posture problems: Many people with back pain find it hard to stand up straight. You may stand crooked or bent, with your torso off to the side rather than aligned with your spine. Your lower back may look flat instead of curved.
  • Muscle spasms: After a strain, muscles in the lower back can spasm or contract uncontrollably. Muscle spasms can cause extreme pain and make it difficult or impossible to stand, walk or move.

Learn To Lift Heavy Items Properly

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Staying active is great for inflammatory back pain, but heavy lifting isnt. Your doctor and/or physical therapist will likely advise you to avoid moving bulky, high-weight objects. And, if you must lift something a piece of furniture or bag of groceries, for example you should use techniques recommended by your physical therapist, such as using your leg muscles more than those in your back.

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Inflammation Vs Inflammatory Conditions

As Dr. Mukai touched upon, autoimmune inflammation that presents as ankylosing spondylitis and rheumatoid arthritis is in a different category.

Its when the body starts attacking itself, she says. Sometimes, this is triggered by an outside event, like a viral infection, which stimulates the immune system. This can cause joint destruction, ligament pain, and soft tissue swelling. Some of these conditions are hereditary while others just seem to happen.

Inflammatory Back Pain Symptoms:

  • Continuous ache in the low back
  • The pain feels like stinging and burning in your lower back, continued to your thighs.
  • Leads to back spasm and tight muscles in your pelvis and hips
  • If you sit or stand for some time, the pain gets even worse.
  • Pain prevents you from standing straight or easily go from standing to sitting.

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Treatment Options For Acute Lower Back Pain

Most low back pain is due to muscle strain and spasm and does not require surgery. To treat the pain, medications such as acetaminophen , nonsteroidal anti-inflammatory agents , gabapentin or pregabalin can be used. NSAIDs suppress inflammation, pain and fever by inhibiting certain inflammation-causing chemicals in the body. Acetaminophen reduces pain and fever, but does not inhibit inflammation. Gabapentin and pregabalin, medications that have been used for antiseizure activity, also have the ability to block pain. Opioids provide pain relief and may at times be prescribed to manage severe back pain. However, opioids have many problems, such as habituation, constipation and lightheadedness, and are avoided when possible and used for the shortest possible duration. Epidural injection is an option if the back pain does not respond to these treatments. Each person is different in terms of response to medication.

Other nonsurgical treatments for lower back pain include Intradiscal electrothermal therapy , nucleoplasty, and radiofrequency lesioning.

What Are Ankylosing Spondylitis Treatment Options

Inflammatory back pain

The treatment of ankylosing spondylitis typically involves the use of medications to reduce inflammation and/or suppress immunity to stop progression of the disease, physical therapy, and exercise. Medications decrease inflammation in the spine and other joints and organs. Physical therapy and exercise help improve posture, spine mobility, and lung capacity.

Aspirin and other non-steroidal anti-inflammatory drugs are commonly used to decrease pain and stiffness of the spine and other joints. Commonly used NSAIDs include indomethacin , tolmetin , sulindac , naproxen , and diclofenac . Their common side effects include stomach upset, nausea, abdominal pain, diarrhea, and even bleeding ulcers. These medicines are frequently taken with food in order to minimize side effects.

Medical research has shown that for persistent ankylosing spondylitis with spinal involvement that is unresponsive to anti-inflammatory medications, both sulfasalazine and methotrexate are ineffective. Newer, effective medications for spine disease attack a messenger protein of inflammation called tumor necrosis factor . These TNF-blocking medications have been shown to be extremely effective for treating ankylosing spondylitis by stopping disease activity, decreasing inflammation, and improving spinal mobility. Examples of these TNF-blockers include etanercept , infliximab , adalimumab , and golimumab . In 2016, adalimumab was approved for the treatment of uveitis .

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Best Vitamins And Minerals

When it comes to inflammation control, these are the 2 most important vitamins and minerals.

Its been proven if you lack one or both of these, your chances of suffering from chronic inflammation are almost double.

1. Vitamin D

A number of studies have linked low levels of vitamin D with increased levels of chronic pain.

One 2009 study looked at the vitamin D levels of people with chronic pain who were using opioid painkillers.

Those who had a deficiency of vitamin D needed almost twice as high a dose of medication to control their pain.

Make sure you get the natural form of Vitamin D, which is Vitamin D3.

2. Magnesium

Magnesium deficiency is becoming a widespread problem around the world. Vegetables contain less and less Magnesium each year and its very easy to become Magnesium deficient.

From personal experience, I can tell you that using Magnesium oil has worked wonders for me and family with any kind of muscle pain and even restless leg syndrome.

The most absorbed type of Magnesium is called Transdermal magnesium, which gets in your body through your skin and is better absorbed than oral Magnesium supplements.

The best Transdermal supplement I know is this one you can read all about Magnesium oil benefits in this post.

When To Seek Medical Advice

You should see your GP if you have persistent symptoms of AS.

If your GP thinks you may have the condition, they should refer you to a specialist in conditions affecting muscles and joints for further tests and any necessary treatment.

Further tests may include blood tests and imaging tests.

Read about diagnosing ankylosing spondylitis.

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The Importance Of An Accurate Diagnosis

The physician will need to take a careful medical history and do a physical exam to look for certain red flags that indicate the need for an X-ray or other imaging test. In most cases, however, imaging such as X-ray, MRI , or CT scan is unnecessary.

There may also be certain clues in a patients medical history. Low back, nonradiating pain is commonly due to muscle strain and spasm. Pain that radiates into the buttock and down the leg may be due to , a condition in which a bulging disc presses on the sciatic nerve, which extends down the spinal column to its exit point in the pelvis and carries nerve fibers to the leg. This nerve compression causes pain in the lower back radiating through the buttocks and down one leg, which can go to below the knee, often combined with localized areas of numbness. In the most extreme cases, the patient experiences weakness in addition to numbness and pain, which suggests the need for quick evaluation.

A persistent shooting or tingling pain may suggest lumbar disc disease. A pain that comes and goes, reaching a peak and then quieting for a minute or two, only to reach a peak again, may suggest an altogether different cause of back pain, such as a kidney stone.

When tumor or infection are suspected, the doctor may order blood tests, including a CBC and sedimentation rate .

Inflammatory Lower Back Pain

Understanding back pain: differentiating inflammatory from mechanical

Although comparatively few patients have low back pain due to a systemic inflammatory condition, the problem can be life long and can impair function significantly. The good news is that treatments can help essentially all patients, and can lead to major improvements.

Seronegative spondyloarthropathies are a group of inflammatory diseases that begin at a young age, with gradual onset. Like other inflammatory joint diseases, they are associated with morning stiffness that gets better with exercise. Sometimes fusion of vertebrae in the cervical or lumbar regions of the spine occurs. Drugs called TNF-alpha blocking agents, which are used for rheumatoid arthritis, are also used to treat the stiffness, pain, and swelling of spondyloarthropathy, when the cases are severe and not responsive to traditional medications

People who have spondyloarthropathy have stiffness that is generally worst in the morning, and have decreased motion of the spine. They also can have decreased ability to take a deep breath due to loss of motion of the chest wall. Its important for the physician to look for problems with chest wall expansion in patients with spondyloarthropathy.

syndrome is one of the forms of spondyloarthropathy. It is a form of arthritis that occurs in reaction to an infection somewhere in the body, and it carries its own set of signs and symptoms. The doctor will look for:

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How Inflammatory Back Pain Symptoms Lead To An Ankylosing Spondylitis Diagnosis

One of the most important things you can do to ensure a prompt and accurate diagnosis is to keep track of your back pain symptoms. You can use an app like ArthritisPower to document when your back pain gets worse and when it eases up.

However, keep in mind that there is no single test or red-flag symptom that can confirm an ankylosing spondylitis diagnosis. Its a clinical judgment from your doctor, based on inputs from a physical exam, blood tests, imaging, and your self-reported symptoms.

The above symptoms of inflammatory back pain, coupled with other results such as X-ray or MRI evidence of inflammation or damage to the sacroiliac joints or the presence of the genetic marker HLA-B27 on a blood test, make it more likely that your back pain is ankylosing spondylitis.

You should also be aware of these other symptoms of ankylosing spondylitis in addition to lower back and hip pain.

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Inflammatory Back Pain At Night

One of the worst things about inflammatory back pain is how it seems to get worse at night. This is because the inflammatory markers are allowed to settle when youre not moving around. Many people find that they wake up from inflammatory back pain at night. Fortunately, there are a couple of simple things you can do to help get better sleep.

  • Stretch Before and After Bed
  • Performing your stretches both right before you go to bed and right after you wake up can help keep the pain at bay through the night. It can also help you start your day without the pain and stiffness common to inflammatory back pain.
  • Mind Your Medications
  • Some studies suggest that corticosteroids may be linked to insomnia. If youre currently taking these, it could be one reason why you arent getting adequate sleep. You may also try taking NSAIDs right before bed to experience relief through the night.
  • Inspect Your Pillow and Mattress
  • If youre sleeping with your spine out of alignment, it could be exacerbating your problem. Usually, a too-soft mattress or a too-large pillow is to blame. If you sleep on your side, try putting a pillow between your legs to keep your lumbar spine straight while you sleep.

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