The occurrence and characteristics of severe pain in patients with axial spondyloarthritis

ObjectivesPharmacological management of axial spondylarthritis (axSpA) seek to control inflammation. Even if successful, available evidence suggests that many patients continue to experience pain. The aim of the current study was to determine the prevalence and characteristics of severe pain, among persons with axSpA. MethodsThe Scotland Registry for Ankylosing Spondylitis (SIRAS) collected clinical and patient-reported data from adults seen in secondary care in Scotland with a clinical diagnosis of ankylosing spondylitis. Questionnaires asked about severe pain (high pain intensity; high pain interference; and extreme/unbearable pain), lifestyle, and various aspects of health. The relationship between severe pain and clinical/patient-reported factors was assessed using logistic regression. Results929 participants had pain data available (73% male; median symptom duration 20yrs). High pain intensity and pain interference were more common (57% and 42%) than extreme/unbearable pain (11%). Prevalence did not differ with age, although women were less likely to report severe pain than men (Odds Ratios (ORs) 0.56-0.61) as were those with longer duration of education, and those from more affluent areas. The odds of severe pain increased with every 1 unit increase in BASFI (ORs 1.44-1.56). Strong associations were also seen with disease activity, spinal mobility, fatigue, poor sleep, and worse quality of life. ConclusionIn axSpA, severe pain is common, with a clear socio-economic gradient and major impact on quality of life. Rheumatologists need to be aware of the large unmet need in terms of pain management in this patient group with around 1 in 9 patients reporting extreme/unbearable pain. KEY MESSAGESO_ST_ABSWhat is already known about this subject?C_ST_ABSO_LIAxial spondyloarthritis is a painful inflammatory arthritis, although the epidemiology of specific pain phenotypes - and severe pain in particular - is unknown. C_LI What does this study add?O_LISevere pain (extreme/unbearable pain, pain of high intensity, or with a high level of interference) is commonly reported among people with axial spondyloarthritis. C_LIO_LIThree-quarters of individuals reporting severe pain still report severe pain two years later. C_LIO_LIPatients with severe pain are characterised by certain demographic characteristics, higher disease activity, poorer function, and a number of other clinical and lifestyle factors. C_LI How might this impact on clinical practice or future developments?O_LIRheumatologists should be aware of the large unmet need in terms of pain management in this patient group. Specific pain management strategies should be considered to complement therapies aimed at reducing inflammation. C_LI