Can NSAIDs Alone Relieve Back Pain in Ankylosing Spondylitis? - Internal Medicine

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Ankylosing spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine and sacroiliac joints, leading to pain and stiffness. Managing pain effectively is crucial for improving the quality of life for individuals with AS. Your son, at 19 years old, has been diagnosed with AS and has experienced varying degrees of pain, particularly in the lower back and buttocks.
1. Can NSAIDs Alone Relieve Back Pain in Ankylosing Spondylitis?
Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first line of treatment for managing pain and inflammation associated with AS. They can be effective in reducing pain and improving function for many patients. However, the response to NSAIDs can vary significantly among individuals. While some patients may find substantial relief with NSAIDs alone, others may require additional therapies, especially if their symptoms are more severe or persistent.
In your son's case, it seems that while he has had some relief from his buttock pain with the use of NSAIDs like Celebrex (salsalate), the addition of back pain may indicate a more complex situation. It is not uncommon for patients with AS to experience varying levels of pain that may not respond adequately to NSAIDs alone, particularly if there is significant inflammation or structural changes occurring in the spine.
Therefore, while NSAIDs combined with appropriate exercise can help manage pain for many, it is essential to recognize that some patients may need additional treatments, such as physical therapy, disease-modifying antirheumatic drugs (DMARDs), or biologic therapies, especially if NSAIDs are insufficient.

2. Could the Back Pain Be Due to an Injury?
The possibility of your son's back pain being related to an injury, such as from playing badminton, is worth considering. However, given that the pain has persisted despite reduced activity and does not seem to worsen or improve significantly, it is less likely to be solely due to an acute injury.
In young individuals, it is indeed possible to experience sports-related injuries, but these typically present with more acute symptoms and often improve with rest. The chronic nature of your son's pain, along with the underlying diagnosis of AS, suggests that the pain is more likely related to the disease process rather than a simple sports injury.
The fact that his CRP and ESR levels have fluctuated but remain relatively low indicates that there may not be significant systemic inflammation at the moment, which is a positive sign. However, the persistence of pain suggests that there may still be localized inflammation or other factors at play.

3. Management Recommendations:
- Continued NSAID Use: It is essential to continue using NSAIDs as prescribed, as they can help manage pain and inflammation.

- Physical Therapy: Engaging in a structured physical therapy program can be beneficial. A physical therapist can provide exercises tailored to improve flexibility, strength, and posture, which are crucial for managing AS.

- Regular Exercise: Encourage your son to maintain a regular exercise routine, focusing on low-impact activities such as swimming, cycling, or yoga, which can help alleviate stiffness and improve overall function.

- Follow-Up with Rheumatologist: Regular follow-ups with a rheumatologist are essential to monitor disease progression and adjust treatment plans as necessary. If NSAIDs are not providing adequate relief, discussing the possibility of DMARDs or biologics may be warranted.

In conclusion, while NSAIDs can be effective for managing pain in AS, they may not be sufficient for everyone, especially in cases with more severe symptoms. A comprehensive approach that includes medication, physical therapy, and regular exercise is crucial for managing your son's condition effectively. Always consult with his healthcare provider for personalized recommendations and treatment adjustments.