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Q&A with Australian Health Practitioners
Stiff and sore back at night. Could my joint pain be inflammatory?
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I have mid thoracic pain and stiffness during the night and it wakes my up quite a bit making me tired. It goes away once being up for 30 minutes.
So far blood tests are normal and xrays only show a little degeneration in the mid spine. I was referred by my GP to a chiropractor, but I haven't gone as of yet.. too busy..
Can anyone give me an idea whether the chiropractor will help based on that? -
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Dr Ryan Hislop
Chiropractor
Ryan Hislop is the Clinical Director at the Orange Chiropractic Health and Wellness Centre. As an experienced and evidence-based diagnostician, Ryan works largely by medical … View Profile
Most of the mechanical spinal problems seen in practice on a day to day basis are related to movement and postural factors. It is rare to hear of patients completely pain free during the day, then suffering from diffuse aching pain at night. Further to this, nocturnal pain is also a well recognised red flag for underlying pathology. It is good to hear that you have had the relevant tests to exclude any obvious sinister cause.
Key features of inflammatory arthritis are:
- morning stiffness (>30mins) and pain that improves on gentle joint movement
- Raised erythrocyte sedimentation rate (ESR) and C-reactive Protein (CRP), which both suggest high levels of inflammatory substrate in the blood. These can be measured via blood tests.
Non inflammatory arthritisis such as osteoarthritis can still produce morning stiffness, but tends to last <30mins as a general rule.
Do you have any discomfort at any tendon insertions, such as your achilles? This may point to more of an autoimmune type inflammation.
As a hunch, it may be worth have a HLA-B27 check done. This is a gene that a proportion of people who have it suffer from autoimmune type inflammatory conditions. The gene is responsible for the immune system identifiying self from foe.
If this is positive, in conjunction with your symptom distribution and characteristics of the pain, ankylosing spondylitis (AS) also needs to be considered.
A trip to the chiropractor would be waranted to do a more thorough spinal examination as there are many unanswered questions here. Further to that, your chiropractor may send you to your GP for some further blood tests, specifically, ESR, CRP, rheumatoid factor, ANA and HLA-B27.
Chiropractors do more than adjust the spine. They are also trained in nutritional medicine and can offer particular help with inflammatory arthridities.
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Dr Irwin Lim
Rheumatologist
Irwin has been a rheumatologist in Sydney since 2003. He is a co-founder and medical director of BJC Health, which consists of a team of … View Profile
Up to 5% of patients with chronic spinal pain have an Inflammatory Spinal disease eg Spondyloarthritis.
It's often difficult to make the diagnosis and a correct diagnosis can often take many years, and in some cases, decades. Frustrating for all.
Blood tests and standard Xrays can often be negative. HLA B27 if negative, does NOT exclude the disease. RF and ANA are not relevant for inflammatory back pain.
Here's more information:
http://bjcconnectedcare.com/2011/10/when-is-your-back-pain-inflammatory/Report this post
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