Inflammatory Back Pain

Inflammatory back pain (IBP), due to an underlying inflammatory disease such as inflammatory arthritis, results in chronic back pain lasting 3 months.

IBP is a symptom complex rather than a condition, and often indicates inflammation of the vertebrae, joints of the spine and entheses – the sites of tendon and ligament attachment to bone

Last Updated: February 23, 2024

Inflammatory arthritis:

  • Axial Spondyloarthritis including Ankylosing Spondylitis (AS)
  • Psoriatic arthritis (PsA)
  • Inflammatory bowel disease (IBD)
  • Psoriatic spondylitis
  • Reiter’s syndrome

  • Tenderness over enthesis sites
  • Observed postural changes
  • Pain or tenderness over the sacroiliac joint, lumbar spine and/or thoracic spine
  • Reduction in the range of movement in the lumbar spine
  • Loss of hip abduction

For IBP in in patients with spondyloarthritis: should get physical therapy and do joint-directed exercises to promote spinal extension and mobility. First-line medications for symptom relief are nonsteroidal anti-inflammatory drugs (NSAIDs). Biologic medications including TNF-alpha and IL-17 blockers may treat spinal or peripheral symptoms.

The Assessment of Spondyloarthritis International Society (ASAS) expert criteria, is a simple and useful tool which you can use to assess your back pain. The criteria comprises the following questions:

  • Have you suffered back pain for more than 3 months?

If yes, then:

  • Did your back pain start when you were aged 40 or under?
  • Did your back pain develop gradually?
  • Did your back pain improve with exercise?
  • Do you find there is no improvement in your back pain when you rest?
  • Do you suffer from back pain at night which improves upon getting up?

 

The criteria are fulfilled if at least four out of five parameters are present.

In this case, please consult with a rheumatologist for further investigation as the pain could be due to a form of inflammatory arthritis.

References:

Physiotherapy-modules-1.pdf (nass.co.uk)

Spondyloarthritis-Fact-Sheet.pdf (rheumatology.org)

Last Updated: February 23, 2024