Which Specialist to Consult for Chronic Back and Joint Pain? - Rehabilitation

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Chronic back and joint pain can be a complex issue, especially when it has persisted for two years, as you described. Given your symptoms and the results of your tests, it’s important to approach this situation methodically.

Firstly, the fact that you have tested positive for ankylosing spondylitis (AS) but have normal X-rays and MRI scans is noteworthy. Ankylosing spondylitis is a type of inflammatory arthritis that primarily affects the spine and can lead to severe, chronic pain and discomfort. However, the absence of visible changes on imaging does not rule out the condition entirely. It is possible to have inflammatory changes that are not yet visible on standard imaging techniques, especially in the early stages of the disease.

Your symptoms of back pain that worsens at night and improves with movement are characteristic of inflammatory back pain, which is often associated with AS. The pain in your knees and heels (plantar fasciitis) could also be related to inflammatory processes, as these conditions can sometimes coexist with AS.

Given your situation, I recommend consulting with a rheumatologist if you haven't already. Rheumatologists specialize in autoimmune and inflammatory conditions, and they can provide a comprehensive evaluation of your symptoms. They may consider additional tests, such as blood tests for inflammatory markers (like ESR or CRP) or even a referral for a specialized imaging technique like a CT scan, which can sometimes reveal changes that X-rays and MRIs do not.

In addition to seeing a rheumatologist, you might also benefit from consulting with a physical therapist. A physical therapist can help you develop a tailored exercise program that focuses on improving your flexibility, strength, and overall function. They can also teach you strategies to manage pain and improve your posture, which can be particularly beneficial for chronic back pain.

If your pain is significantly affecting your quality of life, you might also want to discuss pain management options with your primary care physician or a pain specialist. They can explore various treatments, including medications (like NSAIDs or corticosteroids), physical therapy, or even alternative therapies such as acupuncture or chiropractic care.

Lastly, it’s essential to maintain a healthy lifestyle, including regular exercise, a balanced diet, and adequate sleep, as these factors can significantly impact your overall well-being and pain levels.
In summary, I recommend the following steps:
1. Consult a rheumatologist for a thorough evaluation of your chronic back and joint pain, especially considering your positive test for ankylosing spondylitis.

2. Consider physical therapy to help manage your symptoms and improve your mobility.

3. Discuss pain management options with your primary care physician or a pain specialist if your pain is severe.

By taking these steps, you can work towards a better understanding of your condition and find effective ways to manage your pain. Remember, it’s crucial to advocate for your health and seek the appropriate specialists who can help you navigate this complex situation.