Chronic back pain may not spring to mind as one of the more common problems linked to the autoimmune disease rheumatoid arthritis, or RA. But this is indeed the case, and relief for RA-associated back pain is both necessary and available, according to Interventional Pain Management Specialist Kaliq Chang MD, of Atlantic Spine Center.
Affecting more than 1.3 million Americans and as much as 1% of the population worldwide, RA is among the most prevalent autoimmune disorders, according to the Rheumatoid Arthritis Support Network. RA patients experience symptoms when the body’s antibodies mistakenly attack normal synovial joint fluid, triggering chronic inflammation.
Because the neck, or cervical spine, includes several synovial joints, RA-associated chronic pain more often results in this part of the spine. And while RA can cause swelling and pain in joints throughout the body, the resulting inflammation can destroy facet joints – which support movement and flexibility – down the length of the spine. This can lead to severe pain in the neck and back.
Symptoms of RA associated back pain:
The longer a patient has coped with RA, the more likely they’ll experience symptoms in their spine. Estimates vary, but some suggest that more than 80% of those with RA have dealt with spinal problems. What symptoms might they experience? According to Dr. Chang, these include:
- Joint swelling
- Pain, particularly at the base of the skull
- Less flexibility in the joints of the spine
- Stiffness in the neck and/or back
- Sensation of warmth around affected joints
“In advanced cases of RA, this destruction can even lead to the spinal cord and nerve roots becoming compressed, resulting in moderate or severe back pain,” explains Dr. Chang.
Sciatica can also result if spinal vertebrae slip out of place, placing pressure on the nerve roots in the spine. If that happens, patients may have pain that radiates to the arms and/or legs, experience difficulty walking, lose coordination, or lose bowel or bladder function, Dr. Chang says.
“These extreme symptoms and their consequences underscore the need for anyone with RA to seek treatment for neck or back pain to prevent further damage,” he says.
Chronic Pain Treatment
On top of being necessary to avoid further complications, treating RA-associated chronic back pain is a good idea simply because it’s difficult to live with lasting discomfort, Dr. Chang says.
Back pain can occur because of different reasons, and sometimes it is not quite obvious what causes the pain. Strains sometimes result in back pain, for example, after lifting heavy things. Sciatica, ankylosing spondylitis, as well as a slipped disc can also cause pain. If you experience back pain for some time, it’s best to consult a doctor to determine the diagnosis and choose the proper treatment.
As pain can be caused by different conditions, it is important to understand the cause correctly, and you might need different treatments based on your diagnosis. In some cases, a special training program and over-the-counter drugs can help ease the pain, but sometimes the only option is to have surgery or take pain-relieving medications.
Fortunately, for rheumatoid arthritis pain, a variety of home measures and in-office treatments are available. These include hot and cold packs. Pain and stiffness take a hike – at least temporarily – when hot and cold packs are applied. Either is easy to do at home, with heat packs helping improve blood flow and lessen muscle spasms, Dr. Chang says. Cold packs, which can be applied for 20 minutes at a time 3 to 4 times per day, can help reduce inflammation from RA and are best for flare-ups.
- Medications: Pain severity dictates the best type of pain medications for RA-associated chronic back pain. Painkillers such as aspirin or NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen or naproxen can do the trick for many patients, while prescription-strength pain relievers can be offered at your doctor’s discretion.
- DMARDs: So-called disease-modifying anti-rheumatic drugs, or DMARDs, are prescribed to ease pain and can slow the progression of RA, averting pain flare-ups. These drugs work by blocking chemicals released by the body when antibodies attack joints. While they come with various side effects, your doctor can help you manage these since the drugs may lessen damage to bones and cartilage.
- Spinal injections: Injecting an anesthetic or corticosteroid into the region surrounding RA-associated back pain can lead to significant relief for many patients, Dr. Chang says. And the pain relief can last for weeks or months.
Back Surgery for Chronic Pain
Back surgery: Surgery is almost always the last resort to treat chronic back pain, when more conservative measures don’t work. But various surgical procedures can help RA-associated back pain, including spinal fusion, which removes a diseased joint and bonds the surrounding vertebrae. Also possible is surgery to stabilize and realign the spine, reducing pressure on surrounding nerves, Dr. Chang says.
In general, many back surgeries offer a fast and smooth recovery period and a long-term pain relief. However, there’s always a chance of a failed surgery and some other risks, so in most cases, surgery is not the first treatment choice.
Some patients are able to return home the same day after minimally-invasive types of surgery. This is because the tissues aren’t cut, but rather split during the procedure, which doesn’t suggest a long recovery period. In some patients, painful symptoms go away right after the surgery, while in others the pain eases gradually over time.
Any surgery has a number of potential risks and complications. The most important thing is to discuss possible risks with your medical team, as they can assess your condition, and the exact characteristics of the surgery needed, and will be able to tell you the potential risks. Such information will help you make a good decision.
The risks and complications include excess bleeding during or after the surgery, as well as infections.
Some of the risks are more common than others, for example, many patients experience persistent postsurgical pain or weakness in muscles. Among the more serious issue that can appear after surgery is vein thrombosis. Moreover, there can also be nerve damage. For instance, you can have temporary nerve swelling or even worse, a nerve injury.
Remember, this is the list of potential risks, and it doesn’t necessarily mean that you will experience them. Spine surgeries are quite routine and truly bring pain relief for many patients, so if you hesitate to visit a doctor, you only prolong the pain that you already have. Moreover, proper treatment reduces the chance of symptoms worsening.
The recovery after spine surgeries targets pain control with certain medications. It is also advised to walk, as it speeds up tissue recovery. Such moderate activity also prevents a patient from future complications.
The characteristics of your recovery period will depend on your condition, the type of surgery, and some decisions during the surgery.
Chronic Back Pain Support Therapy
Physical therapy is among the treatments that can be recommended to you after the surgery or as a sole treatment option. A therapist can help you choose the correct activities and back-friendly exercises.
In some cases, patients are even prescribed a brace. It helps control movements. Usually, a doctor gives some instructions on the duration of wearing the brace.
Your treatment plan can include stretches or exercises, massage therapy, heat or cold therapy, practice with assistive gadgets.