Have you had back pain for over 3 months? It could be Inflammatory pain.

Back pain (including neck, upper back and lower back pain) is a common presenting condition in physiotherapy practice. Neck and low back pain have been identified as the leading cause of global disability in 2015 in most countries.

The majority of patients presenting with back pain will be classified as having non-specific mechanical back pain (i.e. pain that is generated by the spine, intervertebral discs and surrounding soft tissue - including muscle strain, disc herniation, etc) However, it is essential to be able to identify patients who fall outside of this category, including those with back pain of inflammatory origin.

Inflammation is a normal result of injury, and actually assists injuries to repair, by flooding the injured tissues with the cells required to commence the healing process. Ongoing inflammation, without a mechanism for injury however, can be a sign of systemic disease, where the body is frequently dealing with inflammation caused by either auto-immune dysfunction or other conditions. An example of such a condition would be rheumatoid arthritis or other forms of inflammatory arthritis (like Spondylitis).

Image: Features of inflammation

Common symptoms that present from inflammatory pain

Onset
The onset of systemic inflammatory arthropathies is quite often insidious (gradual and cumulative), but can be related to viral illness. The onset of symptoms peaks between 20-40 years of age for the Spondyloarthropathies and 30-60 years of age for Rheumatoid Arthritis, but onset outside of these ranges is not uncommon.

Worse on waking
With inflammatory arthropathies, symptoms (joint pain and stiffness) are often at their worst first thing in the morning, lasting for over 30 minutes and improving after being up and about. The time frame is important, Osteoarthritis for example is commonly aggravated in the morning but usually for less than 15 minutes. If the stiffness is “self-reported” i.e. the patient volunteers the descriptive word, this is prognostic of inflammatory symptoms.

Night pain
In the world of Rheumatology, onset of pain in the second half of the night (after 2am say) is what we are looking for, especially if the individual has to get out of bed and move around to ease the symptoms.

Unlike the more typical types of musculoskeletal problems which present in clinic, inflammatory arthropathy symptoms tend to better with activity and worse with rest.

Better with Anti-Inflammatories
Unsurprisingly, inflammatory arthropathy symptoms are often improved with anti-inflammatories.

Swelling
Swelling without trauma either transient or prolonged of the synovial joints is another clue that there might be something inflammatory going on. Especially looking for redness, heat and multiple joints affected particularly of the hands and/or feet.

Because symptoms can come and go over many years, and move from different areas of the body, it can take, on average, 7 years from the onset of symptoms, for patients to be diagnosed with a form of inflammatory arthritis.

Rachel has a special interest in this area. If you have had ongoing pain that is not responding to your current management, Rachel would love to offer you a second opinion. Call the studio to book today 07 5337 9853.