Managing Ankylosing Spondylitis Back Pain: Do NSAIDs and Exercise Always Help? - Internal Medicine

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Managing back pain associated with Ankylosing Spondylitis (AS) can be challenging, especially for a young patient like your son. AS is a chronic inflammatory condition primarily affecting the spine and the sacroiliac joints, leading to pain and stiffness. The management of AS typically involves a combination of non-steroidal anti-inflammatory drugs (NSAIDs) and physical exercise, but the effectiveness of these treatments can vary significantly among individuals.

1. Effectiveness of NSAIDs and Exercise: In the early stages of AS, patients often respond well to NSAIDs, which help reduce inflammation and alleviate pain. However, as the disease progresses, structural changes in the spine, such as fusion of vertebrae or the development of syndesmophytes, can occur. These changes may lead to a decrease in the effectiveness of NSAIDs. It is important to note that while NSAIDs can provide symptomatic relief, they do not alter the disease course. Regular exercise is crucial in managing AS, as it helps maintain spinal mobility, improve posture, and strengthen the muscles supporting the spine. However, the degree of pain relief from exercise can vary. Some patients may experience significant improvement, while others may find that their pain persists despite regular physical activity.

2. Concerns About Exercise-Induced Pain: Your concern about whether the back pain could be due to exercise-related injuries is valid. It is essential to differentiate between pain caused by AS and pain resulting from overuse or improper exercise techniques. If your son has been engaging in activities that put excessive strain on his back, it could contribute to his discomfort. However, if the pain is consistent with the typical patterns of AS (e.g., morning stiffness that improves with activity), it is likely related to the condition itself. The fact that his pain slightly improves in the afternoon may suggest that it is indeed linked to AS, as symptoms often fluctuate throughout the day.

3. Monitoring and Adjusting Treatment: Given that your son has been on various NSAIDs without significant relief, it may be worthwhile to consult with his rheumatologist about alternative treatments. Disease-modifying anti-rheumatic drugs (DMARDs) or biologic therapies, such as TNF inhibitors or IL-17 inhibitors, may be considered if NSAIDs are ineffective. These medications can help control inflammation and slow disease progression.

4. Importance of Regular Follow-Up: Regular follow-up appointments with a rheumatologist are crucial for monitoring disease progression and adjusting treatment plans as necessary. Blood tests, such as CRP and ESR, can provide insights into the level of inflammation and help guide treatment decisions. The values you provided indicate some fluctuation in inflammation levels, which should be discussed with the healthcare provider.

5. Physical Therapy and Exercise Regimen: A tailored exercise program supervised by a physical therapist experienced in treating AS can be beneficial. They can help ensure that your son is performing exercises correctly and safely, minimizing the risk of injury. Stretching, strengthening, and aerobic exercises are typically recommended, focusing on maintaining flexibility and mobility.

In summary, while NSAIDs and exercise are foundational in managing AS-related back pain, their effectiveness can vary. It is essential to monitor symptoms closely, consider alternative treatments if necessary, and engage in a structured exercise program under professional guidance. Regular communication with healthcare providers will help ensure that your son receives the best possible care for his condition.