What Helps Ankylosing Spondylitis Pain?

Treatments for ankylosing spondylitis pain include over-the-counter (OTC) and prescription nonsteroidal anti-inflammatory drugs (NSAIDs), biologic medications, corticosteroid injections, opioids (narcotics), physical therapy, and exercise.

Ankylosing spondylitis is a chronic, inflammatory autoimmune disease that is a rare form of arthritis. It primarily affects the joints between the bones of the pelvis (sacroiliac joints), and the spinal column, ribcage, neck, and skull bones (the axial skeleton). 

Ankylosing spondylitis treatment usually involves a combination of medication, exercise, physical therapy, good posture practices, applying heat/cold to help relax muscles and reduce joint pain, and surgery in severe cases.

Treatments to help ankylosing spondylitis pain include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) 
  • The most commonly used type of medication to treat ankylosing spondylitis pain and stiffness
  • Over-the-counter: ibuprofen (Advil, Motrin) and naproxen (Aleve)
  • Prescription: indomethacin (Indocin, Tivorbex), diclofenac (Flector, Cambia, Zorvolex), or celecoxib (Celebrex)
• Analgesics such as acetaminophen (Tylenol) may also be used for pain relief
• When NSAIDs do not work, sulfasalazine (a DMARD) and methotrexate for arthritis symptom relief are recommended
• Biologic medications may be used for ankylosing spondylitis pain when NSAIDs are not working
  • Tumor necrosis factor-α (TNF-α) antagonists such as infliximab (Remicade), etanercept (Enbrel), adalimumab (Humira), certolizumab pegol (Cimzia), and golimumab (Simponi), may help improve symptoms 
  • Anti-interleukin 17 therapy such as secukinumab (Cosentyx) and ixekizumab (Taltz) may be used in place of anti-TNF therapy
  • The Janus kinase inhibitor tofacitinib (Xeljanz) may be recommended 
• Corticosteroid injections may be used to treat swollen, painful joints (oral corticosteroids are not used)
• Opioids (narcotics) for pain

Physical therapy and exercise can also help ankylosing spondylitis pain and stiffness and maintain flexibility and mobility.

• Exercises include: 
  • Cardiovascular 
  • Stretching
  • Core strengthening
  • Isometric strengthening
  • Dynamic movements
  • Breathing exercises 
  • Fall-prevention exercises 
  • Posture training can help prevent the spine from becoming “frozen” 
  • Heat or cold therapy to relieve pain, stiffness, and swelling
  • Transcutaneous electrical nerve stimulation (TENS) to help manage pain by blocking nerve signals to the brain

Other treatments for ankylosing spondylitis include: 

• Safety measures to minimize accidents caused by limited mobility 
  • Modify the home to decrease the risk of falls
  • Always wear seatbelts in motor vehicles
  • Sleep on a thin pillow to help avoid developing deformities of the neck
  • Limit alcohol
  • Avoid or limit use of narcotics and sleeping pills
  • Avoid high-impact activities and contact sports if the spine is inflexible
• Support groups to help patients cope

Surgery may be used to treat severe cases of ankylosing spondylitis and may include:

• Fracture stabilization 
• Spinal surgery to fuse the bones in the cervical or upper thoracic spine
• Total hip replacement for severe, chronic hip pain and limited mobility
• Wedge osteotomy to remove a piece of bone from a spinal bone (vertebra), followed by realignment of the spine which is braced to heal in a better position