Should I Consider Rehabilitation for Ankylosing Spondylitis Pain?

Q: Should I Consider Rehabilitation for Ankylosing Spondylitis Pain?

Hello, thank you for your inquiry. <br>Here are my responses：<br>1) Initially, I only experienced pain in my left buttock (no pain in other areas). <br>After taking Celecoxib, the pain subsided. <br>However, after stopping the medication for 1.5 months, I began to experience pain

Should I go to a rehabilitation department for stiffness?

Hello Doctor: I am a 20-year-old patient with ankylosing spondylitis.
I would like to ask you a few questions:
1) Initially, I only experienced pain in my left buttock (no pain in other areas).
After taking Celebrex, the pain subsided.
However, after stopping the medication for 1.5 months, I started to have pain in my right buttock (again, no pain elsewhere).
For the past six months, the pain in my right buttock has been intermittent while on medication (the pain worsens if I slightly reduce the dosage).
Interestingly, my left buttock has not hurt since then.
X-rays show inflammation in the left sacroiliac joint, but the doctor said it is not severe.
Can you explain why this is happening (why is my left buttock no longer painful)?
2) If I usually take my medication and keep my levels within the normal range, but experience pain in the sacroiliac joint after some vigorous exercise, is it advisable to continue taking Celebrex regularly and also arrange for rehabilitation (such as heat therapy, electrical stimulation, ultrasound, etc.) at the hospital? Alternatively, is it acceptable to take some immediate anti-inflammatory pain relief medication in addition to Celebrex? (I feel that even if I take the maximum daily dose of 400mg of Celebrex, it takes about a month for the pain to subside after any vigorous exercise.)
3) Do you have any recommendations for emergency anti-inflammatory pain relief medications?
4) When I return for blood tests, is it best to have them done when the sacroiliac joint is not painful? I believe that if the sacroiliac joint is already painful, any abnormal CRP or ESR results may not accurately indicate whether the inflammation is due to post-exercise strain or a loss of medication efficacy.
Is my reasoning correct? Thank you, Doctor.

Ting, 20~29 year old female. Ask Date: 2022/02/24

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
Here are my responses:
1) Initially, I only experienced pain in my left buttock (no pain in other areas).
After taking Celecoxib, the pain subsided.
However, after stopping the medication for 1.5 months, I began to experience pain only in my right buttock (again, no pain elsewhere).
For the past six months, the pain in my right buttock has been intermittent while on medication (the pain worsens with a slight reduction in dosage).
Interestingly, I have not experienced any pain in my left buttock since then.
X-rays showed inflammation in the left sacroiliac joint, but the doctor said it was not serious.
I would like to ask the doctor why this is happening (why is my left buttock no longer painful)? --> The pain from sacroiliitis can fluctuate between sides and is related to the location of inflammation, which may not always be visible on X-rays.
2) If I usually take medication and keep my levels within normal ranges, but after some vigorous exercise, I experience pain in my sacroiliac joint, is it advisable to continue taking Celecoxib regularly and also arrange for rehabilitation (such as heat therapy, electrical stimulation, ultrasound, etc.) at the hospital? Or is it acceptable to take some immediate anti-inflammatory pain relief medication in addition to Celecoxib? (I feel that even if I take the maximum daily dose of 400mg of Celecoxib, it takes about a month for the pain to subside after any vigorous activity.) --> Celecoxib is an anti-inflammatory pain reliever.
If you are currently taking it, you should not take other anti-inflammatory pain medications, as this may not improve pain control and could increase the risk of side effects.
If the effectiveness of Celecoxib decreases, you can ask your doctor to prescribe another anti-inflammatory medication.
3) Are there any specific emergency anti-inflammatory pain medications that you would recommend? --> Each physician has different considerations, and it is best to have your prescribing physician evaluate your situation.
Please consult your treating physician.
4) When I return for blood tests, is it best to have them done when my sacroiliac joint is not painful? I believe that if the sacroiliac joint is already painful, any abnormal CRP or ESR results may not accurately indicate whether the inflammation is due to post-exercise irritation or a decrease in the effectiveness of the medication.
Is my reasoning correct? --> The timing of the tests is unrelated to whether the joint is currently painful or whether you are taking medication.
However, if you are experiencing a cold, fever, diarrhea, or other physical discomfort, it may interfere with the test results.
It would be advisable to wait until your symptoms improve before returning for tests.

Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2022/02/24

More Info

When considering rehabilitation for Ankylosing Spondylitis (AS) pain, it is essential to understand the nature of the condition and the role that rehabilitation can play in managing symptoms and improving quality of life. Ankylosing Spondylitis is a chronic inflammatory disease primarily affecting the spine and the sacroiliac joints, leading to pain and stiffness. The symptoms can vary significantly among individuals, and your experience of pain shifting from one side to another is not uncommon in AS.

1. Understanding Pain Fluctuation: The fact that your left hip pain has resolved while you now experience pain in the right hip could be attributed to several factors. AS is characterized by periods of exacerbation and remission, and the inflammatory process can shift. The medication you were taking, likely a non-steroidal anti-inflammatory drug (NSAID) like Celebrex (Celecoxib), may have been effective in managing inflammation on the left side, but as you stopped taking it, the inflammatory response may have manifested on the right side. This shifting of pain can be due to the body's adaptive mechanisms or changes in activity levels, posture, or even stress levels.

2. Role of Rehabilitation: Engaging in rehabilitation is highly beneficial for individuals with AS. Physical therapy can help maintain mobility, improve posture, and strengthen the muscles around the spine and pelvis. Modalities such as heat therapy, electrical stimulation, and ultrasound can provide symptomatic relief and enhance the effectiveness of your medication. It is advisable to incorporate rehabilitation into your treatment plan, especially during flare-ups. Regular exercise, including stretching and strengthening exercises, can help manage pain and improve function.

3. Managing Acute Pain: In the event of acute pain following physical activity, it is reasonable to continue your regular medication regimen while also considering the use of additional anti-inflammatory medications as needed. Over-the-counter NSAIDs like ibuprofen or naproxen can be effective for short-term relief. However, it is crucial to consult with your healthcare provider before adding any new medications to ensure they are appropriate for your specific situation and do not interact with your current medications.

4. Timing of Blood Tests: Your reasoning regarding the timing of blood tests is sound. It is indeed preferable to have blood tests, such as CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate), conducted when you are not experiencing pain. Elevated levels of these markers can indicate inflammation, but if you are in a flare-up, it may be challenging to determine whether the inflammation is due to disease activity or a response to recent physical exertion. Discussing this with your doctor can help ensure that your treatment plan is based on accurate assessments of your condition.

In summary, rehabilitation is a critical component of managing Ankylosing Spondylitis. It can help alleviate pain, improve function, and enhance your overall quality of life. Regular communication with your healthcare team, including your rheumatologist and physical therapist, is essential to tailor your treatment plan to your specific needs and to adjust it as your symptoms change. Always prioritize a holistic approach that includes medication, physical therapy, and lifestyle modifications to manage your condition effectively.

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