by Chris Miller | Posted on 8/16/2012
Although there are many causes for a sore back, when discussing ankylosing spondylitis (AS) and related types of spondyloarthritis (SpA), there are two overriding types of back pain that are looked at: Mechanical Back Pain - like that caused by an injury such as a herniated disc - and Inflammatory Back Pain (IBP) - like that caused by inflammatory arthritis such as AS.
One of the first steps in making a diagnosis of ankylosing spondylitis when chronic back pain is involved is determining if the pain is mechanical or inflammatory. As Dr. Michael Weisman said at SAA's Denver Educational Seminar in 2008, "The key to making a diagnosis of ankylosing spondylitis is to understand what is inflammatory back pain."
Generally speaking, inflammatory back pain can cause some of the following:
The back pain and stiffness worsen with immobility, especially at night and early morning and can awaken you during the night.
The back pain and stiffness tend to ease with physical activity and exercise such as walking.
The pain sometimes alternates location such as moving from buttock to buttock.
Whereas mechanical back pain usually goes away at night or at rest and will get worse throughout the day or with movement.
An extended report in the Annals of Rheumatic Diseases looked at the prevalence of inflammatory back pain in the United States. The report states that the age-adjusted US prevalence of IBP was between 5 and 5.8% depending on criteria.
The authors of the report conclude that "IBP is associated with spondyloarthritis. Awareness of the prevalence of IBP may be useful for planning future epidemiological studies as well as development and validation of diagnostic and classification criteria for specific clinically defined diseases."
Note that inflammatory back pain by itself should not be used to diagnose ankylosing spondylitis. Instead it is a very important characteristic which the physician considers along with other findings such as x-ray or MRI evidence of sacroiliitis, the detection of the gene marker HLA-B27, or the history of another related physical finding such as Iritis.
The prevalence of inflammatory back pain: population-based estimates from the US National Health and Nutrition Examination Survey, 2009-10
Spondylitis Association of America, spondylitis.org, "Inflammatory Vs. Mechanical Back Pain"
About the writer: Chris Miller is the Director of Programs at the Spondylitis Association of America and is Managing Editor of SAA's news magazine, Spondylitis Plus. He has been at SAA for nine years.
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