Opioid Use and Ankylosing Spondylitis

Medically Reviewed By William C. Lloyd III, MD, FACS
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Ankylosing spondylitis (AS) is a type of arthritis that affects the spine, causing stiffness and pain. One of the primary goals when it comes to managing AS is to decrease this pain. But for some people, that can be challenging. There are several medications available to treat AS, most of which address the underlying inflammation that causes the disease to get worse over time. Treatment guidelines state if someone has exhausted all other therapies, opioid painkillers might be a good option, even though opioids don’t lower inflammation; rather, they mask the pain associated with AS. Regardless of the guidelines, a recent study in the Journal of Rheumatology found chronic opioid use is common among people with AS–and the researchers involved called this “concerning.” That’s because opioids are highly addictive and, even if taken as prescribed, can cause challenging side effects during use and when trying to wean off of them. If you’re taking opioids to manage your AS pain, make sure you’re aware of the risks.

Understanding Ankylosing Spondylitis

Though ankylosing spondylitis primarily affects your back, it can also occur in other parts of your body including your hips, ribs, neck, and shoulders. It causes inflammation, resulting in pain and stiffness. In some cases, the inflammation can even impact your eyes, bowel, heart, or lungs.

When ankylosing spondylitis becomes severe, the inflammation can cause new bone to grow in between the vertebrae of your spine, fusing those segments together. This makes your spine rigid, unable to bend or twist as it previously could. It can also lead to stiffening of your rib cage, making it harder to breathe.

Depending on how far the disease has progressed, the level of pain and disability can range from mild and transient to intense and constant. When pain is high and not well-controlled by other treatments, opioids may offer relief.

Use Opioid Painkillers Judiciously

Opioids bind to certain receptors in the brain, spinal cord, and other parts of the body, and they essentially block your body from feeling pain. They also trigger the release of feel-good endorphins, which boost feelings of pleasure and calm. However, they can have drastic consequences when not taken as prescribed. Every year, about a third of Americans with opioid prescriptions misuse them. Roughly 5% of people in the U.S. who abuse their opioid prescriptions eventually transition to heroin. And 130 Americans die every day from opioid-related drug overdoses.

Even if you’re using opioids as prescribed, if you’re on them for a long time, your body may require progressively higher doses in order to achieve pain relief. This is called a tolerance, which is not the same as addiction. But along with reduced pain relief, using opioids chronically can lower production of endorphins, so you won’t feel as good when taking them. This is one of the reasons why it’s so easy to develop an opioid addiction. Using opioids for a long period of time can also lead to dependence, which means your body becomes used to the medication, and if you stop taking it, you may experience hard-to-tolerate withdrawal symptoms, like nausea, vomiting, diarrhea, excessive sweating, sleep problems, fatigue, tremors, confusion, and even hallucinations. While you’re on opioids, you might have to deal with common side effects like constipation, nausea and vomiting, bloating, irritability, and more.

Are there times when opioids may be appropriately prescribed for ankylosing spondylitis? Yes, but it’s important you and your doctor have explored all appropriate treatment options first. Finding a medication that directly treats the inflammation, rather than one that masks the pain, may be more beneficial in the long run.

However, under a doctor’s care, especially if it’s for short-term use, opioids may help get you through a bad flare-up. Be sure to use them only as directed, and let your doctor know if you have any concerns along the way.

Other Treatments for Ankylosing Spondylitis

The first treatment for ankylosing spondylitis is nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen (Aleve) or ibuprofen (Advil/Motrin). They can help reduce both pain and inflammation.

If you don’t respond well to NSAIDs or develop unwanted side effects like stomach irritation or bleeding, a biologic may be considered. This newer type of medication treats ankylosing spondylitis at the cellular level. For example, tumor necrosis factor (TNF) is a protein found in your cells that sends a signal for your body to start the inflammatory response. By using a biologic drug known as an anti-TNF medication to block the protein from doing its job, inflammation and its painful symptoms can be stopped. Some anti-TNF medications approved for ankylosing spondylitis include:

  • Infliximab (Remicade)

  • Etanercept (Enbrel)

  • Adalimumab (Humira)

  • Certolizumab (Cimzia)

  • Golimumab (Simponi)

Secukinumab (Cosentyx) is another biologic used to treat ankylosing spondylitis. It blocks interleukin-17 (IL-17), a different protein involved in inflammation. Biologics have proven to be highly effective, though due to their effect on your immune system, they can place you at an increased risk for infection.

Other medications that may help decrease pain and inflammation are disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine and corticosteroid injections.

The Bottom Line When It Comes to Opioids and AS

The study published in the Journal of Rheumatology found not only that opioid use is high in people with AS, but also, use of other therapies, like anti-TNF medications, is quite low. We don’t yet know why this is the case, but we do know it’s especially important to be educated about opioids if you’re considering them for pain relief. If you’ve tried other AS treatments with little to no success, opioids may be able to reduce your pain. But make sure you have a thorough understanding of how opioids may affect your body, including potential side effects and the risk of addiction. Use opioids cautiously and stay in touch with your doctor. If you feel like you’re at significant risk of developing an addiction, don’t wait to get help. Contact your physician or call the National Drug Helpline 24/7 at 1-888-633-3239.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Apr 14
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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