Opioid Medication Use in Those with Ankylosing Spondylitis

By Spondylitis Association of America

Wednesday, March 28, 2018

Opioids can be a significant source of pain relief for those experiencing moderate to severe ankylosing spondylitis (AS) symptoms who achieve little pain relief from antirheumatic treatments such as non-steroidal anti-inflammatory drugs (NSAIDs), biologic medications, or disease modifying anti-rheumatic drugs (DMARDs).

A new study published in the Journal of Rheumatology has found that opioid use is more closely associated with subjective disease measures, such as depression, pain, and functional impairment, than with objective disease activity measures, such as increased systemic inflammation.

The study followed a pool of 706 patients with AS for the course of at least two years, conducting comprehensive evaluations of disease activity, radiographic progression, and functional impairment using standard AS disease assessment tools, including the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)[1], the Bath Ankylosing Spondylitis Functional Index (BASFI)[2], and the Bath Ankylosing Spondylitis Radiology Index (BASRI) - which measures radiographic severity. Medications taken and inflammatory activity were also tracked and documented at each visit.

The BASDAI and BASFI scores demonstrated that those on opioids reported experiencing higher disease activity and functional impairment. Additionally, they were more likely to use other supplemental drugs in conjunction with opioids, such as antidepressants and muscle relaxants, compared to non-opioid users.

However, the erythrocyte sedimentation rate (ESR)[3] and C-reactive Protein (CRP)[4] tests, which measure systemic inflammation, indicated that opioid and non-opioid using patients experience similar levels of inflammation, suggesting that the pain in AS may come from sources other than inflammation alone.

Other data collected through this study showed that opioid use is also associated with longer disease duration, radiographic severity, smoking, depression, cardiovascular disease, and lack of exercise.


[1] The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is a quick and subjective measure in which patients classify their discomfort level on a scale of 1-10 in six different categories, such as fatigue and stiffness, with the numbers then being averaged.

[2] The Bath Ankylosing Spondylitis Functional Index (BASFI) is a quick and subjective test that rates a patient’s confidence in their ability to complete certain activities or tasks, such as putting socks on or standing unsupported for 10 minutes without discomfort.

[3] The erythrocyte sedimentation rate (ESR) is a blood test used to detect inflammatory activity in the body. Since inflammation causes cells to lump together, the cells are more densely packed when inflammation is present. The ESR measures the distance the cells descend in a test tube in one hour – the greater the distance they have descended, the more inflammatory activity.

[4] The C-reactive Protein (CRP) test is a similar blood test that identifies the amount of CRP in a patient’s blood. High levels of CRP indicate high rates of inflammation.


Read stories from people living with spondylitis and chronic pain

The Price of Pain Relief
Escaping the Opioid Jungle


Additional resources on chronic pain

Pain in Spondylitis
Tackling Chronic Pain
Central Sensitization and its Role in Chronic Pain
Seminar on Pain Management


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