Pain Management for Your Back

The best defense against back pain from ankylosing spondylitis (AS) is controlling your disease with a daily treatment plan. It will usually include medications your doctor recommends. When the pain is worse than normal and you’re having a flare, your doctor may have you try other drugs.

But you can take steps on your own, besides meds, to ease pain and stiffness.

Ways to Get Started

Work with a physical therapist. Exercise is an important part of everyday treatment. When you strengthen the muscles that support your spine, you can boost your flexibility and lower pain.

It’s best to work with a qualified therapist. She can make sure your form is right.  When some exercises are done the wrong way, they can make you feel worse.

A trainer can keep you on the right track and motivated. In addition to strength training and stretching, your program might include exercising in water (hydrotherapy), posture training, and deep-breathing exercises.

Having a flare? Use heat or ice. A physical therapist may recommend either hot or cold therapy.

You can use a cold pack on inflamed areas to help with swelling. And you can use heat to loosen up tight muscles and ease joint stiffness. Take a warm shower before a workout, for example, to help you move better.

Take frequent breaks. If you don’t move around a lot, your symptoms may be worse. If you have to sit for a long time at work, try to get up every hour or so to stretch or walk around. (Your doctor can write a note so that you can take regular breaks.)

Practice good posture. Hunching over may make back pain feel better for a short time. But it only strains your spine more. There is also a risk that your vertebrae -- small, linked bones that form your backbone -- could fuse in a bent-forward position.

Ask your spouse, co-worker, or friend to remind you to keep your back straight. If you work at a computer, make sure your station is set up to promote good posture. 

Eat smart. Eating healthy food and watching your portions can control your weight, and that’s important. Extra pounds mean extra pressure on your spine and joints. While there’s no one diet that’s recommended for AS, foods with anti-inflammatory properties -- such as those high in omega-3 fatty acids (like salmon) -- could help.

Stop smoking. Lighting up makes AS more damaging and hard to treat. Ask your doctor about things that can help you ditch the habit.

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Medicines to Control Pain When You’re Having a Flare

Nonsteroidal anti-inflammatory drugs (NSAIDs). These include medications like ibuprofen and naproxen. NSAIDs, which lower inflammation, may be a part of your regular daily treatment plan. If they are, don’t take more than prescribed without talking with your doctor. If NSAIDs aren’t a part of your treatment plan, talk with your doctor about them.

Corticosteroids. If NSAIDs don’t do enough for your joint pain, your doctor may use these drugs. You might get shots into stiff, painful joints to help with swelling and give you temporary relief. But your doctor won’t recommend this too often because they can damage soft tissues and bone.

About 40% of people with ankylosing spondylitis have inflammation in their eyes (uveitis). If you have this, corticosteroid eye drops can lower swelling and ease irritation.

Steroid pills are also sometimes used to help with eye or joint flares.

Muscle relaxants. Your doctor may prescribe these to help with painful muscle spasms, ease stiffness, and make it easier to exercise. You’ll probably only take them for short times.

Opioids. While these drugs aren’t usually one of the first things your doctor will try, they can help with severe pain that doesn’t get better with NSAIDs or other treatments. Opioids can be habit-forming though, so you can’t take them for a long time, and it’s important for your doctor keep an eye on you while you take them.

WebMD Medical Reference Reviewed by Tyler Wheeler, MD on December 14, 2018

Sources

SOURCES:

National Institute of Arthritis and Musculoskeletal and Skin Diseases: “What is ankylosing spondylitis?”

Grant Louie, MD, assistant professor of medicine, division of rheumatology, Johns Hopkins Medical Center.

Mattey, DL, Journal of Rheumatology, December 2011.

Spondylitis Association of America: “Ankylosing Spondylitis,” “Exercise and Posture.”

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