Unmet Pain Management Needs Evident in Axial Spondyloarthritis

patient back exam, spine xray
Investigators compared differences in pain reports between patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis to assess how pain sensitivity was associated with disease and health outcomes.

Patients with axial spondyloarthritis (axSpA) often have chronic pain, and patients with higher pain sensitivity had poorer disease trajectories and health outcomes, according to findings published in Rheumatology.

In this population-based, cross-sectional, cohort study, researchers recruited patients with axSpA (N=175) between 2011 and 2014, and analyzed their medical history, physical and mental function, and pain sensitivity.

Patients were 46% women with a mean symptom duration of 27 years (standard deviation [SD], 14). Compared with non-radiographic axSpA (nr-axSpA), patients with ankylosing spondylitis were older (P <.001), more likely to be men (P <.001), had longer symptom duration (P <.001), had higher C-reactive protein concentrations (P <.05), and more likely to be smokers (P <.05).

Among all patients, 44% reported chronic pain and 33% reported regional pain at an average of 4.8 regions (SD, 4.3). The average pain intensity was 35 mm (SD, 27) and 42% expressed that their pain was unacceptable. Mean pain threshold was 30.1 kPa (SD, 15.0), tolerance was 62.5 kPa (SD, 26.5), and temporal summation index was 0.66 (SD, 0.55).

Pain tolerance was associated with disease severity (P £.001), unacceptable pain intensity (P £.001), gender (P =.001), duration of symptoms (P =.001), age (P =.002), fatigue (P =.004), anxiety (P =.017), and number of painful regions (P =.036).

This study may have been biased by the choice to exclude patients who were unable to withdraw from the use of pain medications for 48 hours prior to examination. The most severe patients were most likely not represented in these results.

“The results indicate that patients with AS and nr-axSpA […] have a similar pain burden and they highlight large unmet needs regarding individualized pain management,” the study authors concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Mogard E, Olofsson T, Bergman S, et al. Chronic pain and assessment of pain sensitivity in patients with axial spondyloarthritis: results from the SPARTAKUS cohort. J Rheumatol. 2020;jrheum.200872. doi:10.3899/jrheum.200872