Back pain that appears upon waking: what are the treatments?

I am 45 years old and for over 10 years I have been suffering from annoying back pain that wakes me up in the morning, before the alarm goes off, and which I treat with common anti-inflammatories. I have had numerous visits and MRIs, with inconclusive results. What could my problem be and how is it treated?

He replies Carlo Selmihead of Rheumatology and clinical immunology, Humanitas Institute, Milan (GO TO THE FORUM)

The backache a very common symptom that affects most Italians at least once a year; often localized in the cervical and lumbosacral regions of the spine. In over 90% of cases the pain has mechanical characteristics, that is, it worsens with movement or standing and instead improves with rest, therefore having a greater intensity in the evening than in the morning. These cases tend to have spontaneous resolution after a few days to a few weeks of use anti-inflammatories or painkillers, to then recur after a period of relative well-being. The cause is difficult to identify, as muscular mechanisms coexist alongside degenerative phenomena of the spine and intervertebral discstypically after the age of 50.

Symptom of spondyloarthritis

In a minority of cases, however, back pain has different characteristics because it arises at a young age, has a continuous trend over time and above all it worsens with rest, associated with spinal stiffness upon awakening lasting even a few hours. This type of back pain defined inflammatory and can be the presenting symptom of spondyloarthritis, that is, a family of chronic rheumatological diseases which, unlike the more well-known rheumatoid arthritis, can also affect the spine, with inflammatory phenomena. In addition to the characteristics of the symptom, the possible presence of signs such as inflammation of some parts of the eye must be investigated (uveitis), of the joints (arthritis), the insertions of the ligaments (enthesitis) or skin (psoriasis).

The HLA-B27 gene test

In some cases it is indicated to evaluate with a blood test the presence of a gene called HLA-B27 which, although not diagnostic, is present in most people with spondyloarthritis. Rapid recognition of the disease is also based on carrying out a radiography and one magnetic resonance imaging, especially of the pelvis, as the sacroiliac joints are often the most affected point of the spine. Today they exist innovative therapies which allow excellent control of inflammation and pain, preventing spinal deformities which were observed more frequently in the past.

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