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Pain and Your Emotions

Ankylosing Spondylitis is a chronic type of arthritis that affects mainly your spine and related joints. It is characterized by pain and stiffness in the back and hips, which is caused by inflammation in the joints. People with AS can experience limitations in their ability to move because of pain and inflammation. Over time, the vertebrae in the spine can sometimes fuse, which itself may cause pain and stiffness.

Chronic pain and ankylosing spondylitis

Ankylosing spondylitis progresses differently in different people. One of the most common symptoms that accompanies the disease is chronic pain. Many AS patients are able to successfully manage their pain using over-the-counter pain medications or prescription pain medications and anti-inflammatory medications.

Some people, however, experience “breakthrough pain,” that can feel intense and debilitating. For these people, the pain of AS may further limit their activities. Experts recommend working with your medical team to develop strategies to manage pain if you experience pain even when you are taking pain medication.

Chronic pain depression

Depression is a common symptom for people dealing with chronic illnesses as well as with chronic pain. Pain is perceived as a danger and triggers our threat—our fight or flight—response. Our bodies are wired to flee threats. But pain is an internal signal, and we tend to experience heightened stress, anxiety, and fear in the face of long-standing pain, especially when we can’t escape it.

The challenge is that in an effort to call attention to the “threat” that is our pain, our body becomes more sensitive to the pain signals. The more anxiety and distress we feel, the more threat-sensitive areas of our brains become activated, which in turn increases our sensation of pain.4

Feeling trapped with continual pain and limited activity can cause people to become anxious and depressed. And those feelings can amplify the sensation of pain and can cause you to do less and experience fewer positive moments to counteract the difficult ones.

Depression and people living with ankylosing spondylitis

To get a handle on how common depression is for people diagnosed with ankylosing spondylitis, researchers recently reviewed multiple studies. Their results showed that depression is common in AS, with mild depression occurring in 38% of people who were evaluated using a common tool to measure depression and 15% experiencing moderate depression.

The researchers also determined that people with greater levels of depression had more severe disease activity and more limitations on their ability to function. The implication is that it is important for doctors to assess and treat depression in their patients with AS. It is also important for patients to be aware of the risk of depression too, especially younger patients and those with more severe disease and impairment.5,6

Treating depression could help in a few ways, because depression is known to increase pain, so it may contribute to patients experiencing more severe disease and more physical limitations.6

  1. Diagnosis of ankylosing spondylitis. Spondylitis Association of America. Available at Accessed 1/28/19.
  2. Ankylosing spondylitis. Lab Tests Online, American Association for Clinical Chemistry. Available at Accessed 1/28/19.
  3. Erythrocyte sedimentation rate (ESR). Lab Tests Online, American Association for Clinical Chemistry. Available at Accessed 1/28/19.
  4. C-reactive protein (CRP). Lab Tests Online, American Association for Clinical Chemistry. Available at Accessed 1/28/19.
  5. Kim K, Cho C. Anemia of chronic disease in ankylosing spondylitis: improvement following anti-TNF therapy. Archives of Rheumatology. 2012 June;27(2):90-97. doi: 10.5606/tjr.2012.014.
  6. Anemia of chronic disease. National Organization for Rare Disorders. Available at Accessed 1/28/19.
  7. Lab test guide. Arthritis Foundation. Available at Accessed 1/28/19.


  • mocoates62
    7 months ago

    I have Spondylitis and also several very painful back and neck problems.My pain specialists let me and many other gk because they stopped accepting my insurance. I have been without all pain meds that I need and have wonderful results with , I could actually have a LIFE and pain controlled ! I cry often one reason being the thought of accepting the fact that I will probably ave to live w this horrible pain until I can get Medicare in 2YEARS !! I can’t fjnd a pain Dr !😪

  • Catz
    2 weeks ago

    So sorry that you have to go through this without any meds.
    You are in my thoughts and prayers..

  • Lawrence "Rick" Phillips moderator
    7 months ago


    Here is a web site I found that attempts to match Pain doctors with patients. Obviously I do not know where you live but maybe one will jump out.

    It is likely a long shot to think you will find one using that list. But maybe it will put on the road to a solution.

    Does your Rheumatologist have any suggestion? I found the one I use by asking my doctor. Again that is likely a long shot, but maybe not?

    I wish you the very best and please check back with us so we know if you will find a solution. I wish you the very best.

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