Podcast: Arthritis & Back Pain-Part 2: Solutions & Treatments

Full Transcript:
Released 9/26/2023

PODCAST OPEN:            
You’re listening to the Live Yes! With Arthritis podcast, created by the Arthritis Foundation to help people with arthritis — and the people who love them — live their best lives. If you’re dealing with chronic pain, this podcast is for you. You may have arthritis, but it doesn’t have you. Here, learn how you can take control of arthritis with tips and ideas from our hosts and guest experts. 

MUSIC BRIDGE 

Cristina Schaefer: 
Welcome to the Live Yes! With Arthritis podcast. Today I'm your host, Cristina Schaefer. You may have heard me on the episode about tackling arthritis challenges for patients of color and in part one of this two-part series. I was diagnosed with RA 18 years ago and have been a longtime volunteer with the Arthritis Foundation in both local roles in the Houston area and nationally. Today, I'll be talking about back pain and arthritis. 

Chronic back pain: It's a reality for so many. In part two of this episode on arthritis-related back pain, we'll explore key treatments and strategies to help relieve it. Once again, we welcome back our expert, Dr. Vivian Bykerk. Dr. Bykerk is a rheumatologist at the Hospital for Special Surgery in New York. Welcome back, Dr Bykerk. 

Dr. Vivian Bykerk: 
Thank you. Good to be back. 

Cristina Schaefer: 
Let's jump right in. If someone is experiencing back pain, what steps do you recommend they take? 

Dr. Vivian Bykerk: 
Well, they need a diagnosis. Even doctors are the worst self-diagnosticians, so I would never think anybody could self-diagnose. You need a diagnosis. You need a plan. You need a treatment plan. That treatment plan may include a form of medication that's countering inflammation, depending on what the cause is. 

So, if you have spondylitis of any sort, that might involve what we call non-steroidal anti-inflammatory drugs, or NSAIDs, like ibuprofen, naproxen — the list is long — that can help relieve pain. In fact, that will help relieve pain in degenerative arthritis as well. Most people don't want to be dependent on medications, but sometimes you need to take them for some time. 

If it's SpA [spondyloarthritis], and it's causing enough restriction and chronic pain, we would typically use a biologic. Or we might use a medication such as Otezla. These are medicines that are known to treat those conditions. And there are now different biologics, meaning proteins that are meant to target certain inflammatory proteins in the inflammatory cascades that happen in these inflammatory arthritis conditions. 

And basically, there's three classes now: those that target what we call TNF-α; those that target interleukin-17; and those that target interleukin-12 and/or -23. There are increasingly those. And then there's another group of medicines that we call JAK inhibitors, Janus Kinase inhibitors, and these work within cells to block certain pathways that are contributing to inflammation of the spine.  

Cristina Schaefer: 
Surgery is often seen as the last resort to arthritis-related back issues. You specialize in non-operative spine care. What exactly does that mean?

Dr. Vivian Bykerk: 
Really, it means we, as rheumatologists, focus on forms of arthritis that are caused by inflammation. So, you know, we discussed last time that: Arthritis, or pain in the back anyway, can be related to an actual rheumatic disease. Related to ankylosing spondylitis, or linked with ankylosing spondylitis and say other conditions like psoriatic arthritis. That's the most common reason we deal with back pain. 

The others might be consequences of having other forms of inflammatory arthritis that have impacted how the back functions and its strength and so on. But as a rheumatologist, we mostly deal with ankylosing spondylitis and spondylitis-related arthritis. So, I'm gonna call it SpA. 

Cristina Schaefer: 
What are the most common treatment strategies you employ for different types of arthritis-related back pain? 

Dr. Vivian Bykerk: 
Very often, we will try non-steroidal anti-inflammatory drugs in inflammatory causes of arthritis in any part of the body, and the spine has its areas where inflammation occurs. These NSAIDs can very much help reduce pain and reduce stiffness, but they don't modify the disease. So, by NSAIDs, I mean ibuprofen, naproxen, meloxicam, celecoxib. These are all types of NSAIDs that, if a patient had AS, or ankylosing spondylitis or any form of SpA, they may have tried these. 

Then, more often than not, if the pain is enough that we're at a patient's losing range of movement in their spine, it's impacting their ability to live their lives, causing continuous pan and/or stiffness — that usually implies there's ongoing inflammation. And that is when we will go to therapy that can tackle that. There are oral forms and there are injectable forms, so-called biologics. 

Cristina Schaefer: 
How do these treatments work in the body? 

Dr. Vivian Bykerk: 
Inflammation is complicated, but it's mediated via the immune system. And the immune system has different kinds of cell pipes, and they have messengers that go from cell to cell. And these treatments target the messengers, or where the messengers bind to cells. 

For instance, the TNF-alpha inhibitor, TNF inhibitor, will obviously inhibit TNF [tumor necrosis factor], usually where it's inserting into the place of inflammation or area of inflammation in the spine. And it will take it out. And by doing so, it locks that inflammatory cascade that the immune system is — for reasons nobody knows yet —  the inflammatory cascade is literally attacking the spine. And as it causes damage, it will be replaced by scar tissue and maybe permanent damage. So, we're trying to modify the disease and prevent the damage. 

Cristina Schaefer: 
How effective are those treatments? 

Dr. Vivian Bykerk: 
I just mentioned one, but there are some others. So, there's, as I said, and other messengers. IL-17 [interluken-17], so the anti-IL-17 biologics are available. There are also anti-IL-12 and anti-IL-23 biologics. And then there are what we call targeted synthetic advanced therapies that are oral. They’re pills. And those will similarly interfere with the pathways, the immune pathways that are causing this; but do so by it actually affecting the cells. 

Those all are very effective for many, many people. Nothing’s ever 100%. We usually have to try and see which works. But people will notice dramatic improvements, feel 80% better, 70% better. And if you’re sort of living with a seven out of 10 pain and you can get down to a one or a two out of 10, or maybe even many days or weeks of no pain, that’s an incredible response. 

PROMO: 
Thank you for your support of the Arthritis Foundation, which makes this podcast possible. We’re the largest nonprofit organization dedicated to conquering arthritis, the nation’s #1 cause of disability. To give a gift to support this podcast and other life-changing resources, go to https://www.arthritis.org/?form=FUNMPPXNHEF&element=xtyuunbvarthritis-dot-org-slash-donate. 

Cristina Schaefer: 
At what point do you recommend physical therapy or rehabilitation? Is that early on in the diagnosis, or is that after some time on medication? 

Dr. Vivian Bykerk: 
I recommend it at birth. I am a big fan of physical therapy and pretty ... I mean, obviously… I’m not gonna recommend it when someone's in the worst of their inflammation. But as soon as it starts to come under control and we can start to do some rehabilitation, and get muscles back and movement back, that's when I'm going to recommend it. And physical therapy is… It's a process. And it's something you may do on your own for your whole life. I've had patients who became swimmers and had incredible management of their SpA symptoms. 

Cristina Schaefer: 
That leads us right into our next question, which is: What strategies can patients take on their own to relieve arthritis-related back pain? 

Dr. Vivian Bykerk: 
Our spines were meant to move, and they're meant to be in a certain alignment. One strategy is don't sit a lot. Sitting shortens the muscles that are at the hip, you know, between the abdomen, spine and hip. And that will throw the mechanics of your back right off and aggravate anything you already have. So, movement is important. 

Walking regularly, getting up regularly. Doing stretches that are taught to you in physical therapy. Often yoga is great. Often tai chi can be great. You know, it's different for everybody. It's a learning process, and trial and error for each person. But doing it under the care or supervision of a physical therapist to figure it out is super helpful. 

I think anybody who has an inflammatory condition, of the spine or joints for that matter, needs a team. And they need their physical therapist. They need their form of exercise that makes them feel good and feel happy. I think that's part and parcel of treating this. A pill or an injection is not going to do it all. 

Cristina Schaefer: 
How can someone prevent arthritis-related back pain, or is this even preventable? 

Dr. Vivian Bykerk: 
Great question. By the time you have ankylosing spondylitis, obviously you can't prevent it. If you know your family has it, a very strong history in the family, this is one of those genetic forms that could run in the family, ankylosing spondylitis. I think a healthy lifestyle, I think not smoking… Getting a decent amount of exercise or physical activity may help prevent. But we don't really know what's going to prevent, and we don't know what triggers it. And I have colleagues that are pediatric rheumatologists who say, "It's already starting in youth," and maybe that's true. I don't know. 

Cristina Schaefer: 
If a patient has limited resources, and they can only do maybe one or two things to get relief, what's the No. 1 thing you recommend? 

Dr. Vivian Bykerk: 
Get up and move. See your doctor to get a diagnosis and then get the right treatment. But get up and move. Keep moving. 

Cristina Schaefer: 
Absolutely. Always keep moving. Well, I know that this is going to be a big eye-opener for many people. As someone who had a doctor tell them, many, many years ago, that back pain and arthritis were completely unrelated, I think that this is such an important topic to highlight ... and to really bring attention to. 

Dr. Vivian Bykerk: 
Let me just address there. I see lots of patients with peripheral arthritis, particularly rheumatoid arthritis. What happens there? Maybe it's involved the ankles and feet. So, what does that do? It throws off your gait. What do you do? You lose muscle mass, so the muscles, your core strength, goes down, and you end up with back pain. Or you move the wrong way, and you end up with back pain, sort of mechanical type pain. Same things apply. You know, one has to do physical therapy, one has to get moving, and one has to correct all the factors that are contributing to the back pain. And this is doable for everybody. 

PROMO: 
All year long, the Arthritis Foundation is putting a spotlight on how serious chronic arthritis pain really is. We’re also sharing inspirational stories, as well as tips, solutions and resources to help manage your specific type of arthritis pain. Visit https://www.arthritis.org/painarthritis.org/pain. 

Cristina Schaefer: 
We like to pose questions on the Arthritis Foundation's social media outlets to bring into these conversations. And the Arthritis Foundation posed this question: What is your top solution for relieving back pain? I'd love to hear your feedback on some of these, Dr. Bykerk. Cindy Seik said, “Yoga,” as you mentioned. “Water fitness and back decompression with meditation.” 

Dr. Vivian Bykerk: 
Check, check, check. I mean, yoga, I agree with all that. I think those are important. You know, when people are stressed and their muscles are tense, their pain will be worse. Their sleep will be worse. And then their pain will be worse. So, getting sleep, reducing stress, are all important ways to help yourself. 

Cristina Schaefer: 
Arthritis Rachy said, "Bath, hot water bottle or ibuprofen gel." 

Dr. Vivian Bykerk: 
All reasonable approaches. I think heat probably helps back pain more often than ice. And using that before you go to sleep, in however you choose to, and some gentle stretching, will probably lead to a better night or a better day. 

Cristina Schaefer: 
And one more here from Ryan Loves It 0115: "Using a heat blanket helps relieve the pain and helps me relax. Definitely recommend." 

Dr. Vivian Bykerk: 
Highly agree. 

Cristina Schaefer: 
Very good. Well, I think for me, one of the biggest takeaways is the reminder to always just keep moving, even when you're in pain. It sounds so tempting to just sit still when you're in pain, but it's so important to keep moving. What are your top takeaways that you'd like people to take from this episode? 

Dr. Vivian Bykerk: 
You know, I think there are solutions and ways to help everybody. No one should think there's nothing that can be done. If a doctor says that, if your general physician says nothing can be done, it's not true. Join support groups. Contact the Arthritis Foundation. Find the avenues for you. 

We've talked about medications that can help. We've talked about lifestyle factors that can help. We've talked about exercise being pivotal and other tricks that can help relieve pain. They're all important. 

Cristina Schaefer: 
Well, thank you so much for your time, Dr. Bykerk. You've shared so much great information in this two-part series, and we truly appreciate it. 

Dr. Vivian Bykerk: 
Great. I’m hoping that these messages get across to many more and that they'll get relief. Thank you for including me. 

PODCAST CLOSE: 
Our special two-part series about arthritis and back pain was brought to you in part by AbbVie, Bristol Myers Squibb and Janssen. This podcast is also made possible in part because of the generosity of our donors. Thank you for pitching in. 

The Live Yes! With Arthritis podcast is independently produced by the Arthritis Foundation. This podcast aims to help people living with arthritis and chronic pain live their best life. People like you. For a transcript and show notes, go to https://www.arthritis.org/liveyes/podcast. Subscribe and rate us wherever you get your podcasts. And stay in touch!