Public health

Don’t overlook psychological toll of AS pain and incapacity: study


People with ankylosing spondylitis experience high levels of chronic pain that consistently impair their daily functioning and cause severe psychological distress, an Australian study has found.

An online survey conducted by Victorian researchers received responses from 161 people with ankylosing spondylitis (AS) or undifferentiated spondyloarthritis.

The patients reported that their symptoms had started on average around the age of 23, but it took around three years to seek help and nine years before they received a diagnosis of AS.

When assessed by the Brief Pain Inventory (BPI), participants reported high levels of pain both within the last 24 hours (average pain score 4.26 on scale of zero to 8) and over the last week (average pain score 4.48)

And as expected with a disease characterised by flares, respondents reported significantly higher scores for worst pain experienced in the previous week (average 6.49).

The high levels of chronic pain in AS and undifferentiated spondyloarthritis interfered with participants daily living activities about 50% of the time or more for all categories including work, relationships, walking and sleep.

People with AS also reported extreme levels of psychological distress as assessed by Depression, Anxiety and Stress Scale Short Form‐21 (DASS-21) scores. There was no difference between males and females with AS in depression, anxiety and stress scores, and the scores were significantly correlated with average chronic pain levels.

There was also a significant, positive relationship seen between the pain interference variables and depression, anxiety and stress.

Writing in the journal Musculoskeletal Care, study author Kate Kelly from Victoria University, Melbourne, said the findings confirmed the diagnostic delays and serious emotional distress experienced by people with AS and undifferentiated spondyloarthritis.

“It highlights a need for health professionals to have a deeper understanding of the implications of chronic disease. While often the greatest presenting problem may be physical in nature  …  the psychological impact should not be ignored and support

should be provided and/or readily available for individuals diagnosed with chronic rheumatological disease,” she wrote.

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