Ankylosing spondylitis (AS) pain is often described as sharp, shooting, or burning. Stiffness is also a common, uncomfortable symptom that accompanies it. No matter what sort of AS pain you’re experiencing, you can take steps to help keep it under control.

Take control of AS pain with medications

There are prescription and over-the-counter drugs to help relieve the pain and stiffness of AS. AS is an inflammatory condition. So the first line of defense is often nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen (Aleve) or ibuprofen (Motrin IB, Advil). NSAIDs are available over the counter or by prescription.

If NSAIDs don’t help your pain or they cause gastrointestinal bleeding or other negative side effects, your doctor may prescribe a tumor necrosis factor (TNF) blocker. These medications block a protein that causes inflammation. Some TNF blockers are adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade).

Having too much of a cytokine called interleukin 17 (IL-17) in your body causes chronic inflammation. IL-17 inhibitors block this substance. The U.S. Food and Drug Administration has approved the IL-17 inhibitor secukinumab (Cosentyx) to treat AS.

Narcotic painkillers may be prescribed for severe AS pain that doesn’t respond to other treatments.

When using any pain medication, take it as directed to stay ahead of the pain. If you wait until you’re in severe pain, you may not get the relief you need.

Other ways to take control

Most health professionals agree that staying active is the most important thing you can do to take control of AS pain. A daily dose of low-impact exercise such as swimming, yoga, or Pilates keeps your joints fluid and helps ease pain and stiffness. It also helps you maintain a healthy weight and is good for your health overall. Other steps you can take to control AS pain are:

1. Stretch throughout the day

Stretching is helpful to relieve stiff muscles. It also helps elongate your muscles and keep them flexible. When done correctly, stretching improves posture and keeps your spine aligned. A good time to stretch is any time you’ve been sleeping or sitting for an extended period.

2. Practice good posture

Good posture helps reduce stress on your spine and back muscles. For people who face spinal fusion due to AS, consistently practicing good posture may mean the difference between the spine fusing straight or curved. Here are a few tips for achieving good posture:

  • Sit on hard, straight-backed chairs instead of soft chairs and sofas.
  • Keep your seat at the right height while working at a desk.
  • Use a lumbar support cushion.
  • Limit the number of pillows you sleep on, and sleep as flat as possible.
  • Take breaks throughout the day to stretch, do wall sits, or lie flat on the floor.

3. Lose extra weight

Extra pounds put extra weight on your joints. This may cause pain and, in some cases, fractures.

If you’re overweight, take inventory of your eating habits to see where you can improve. Opt for a diet low in unhealthy fats and sugar and high in fiber, whole grains, and lean protein. Limit sweets, fried foods, and processed foods. Make sure you’re exercising consistently.

If you need help losing weight, consult your doctor or a registered dietician.

4. Try hydrotherapy

Hydrotherapy is simply exercising in a pool of warm water. The water helps soothe joints and muscles and allows you to exercise without fighting gravity. According to the National Ankylosing Spondylitis Society, when exercising in water that’s waist deep, you weigh half of what you weigh out of water. Water also offers gentle resistance to help you build strength and endurance.

Hydrotherapy is done under the supervision of a physiotherapist. It’s often a comfortable and relaxing type of exercise for people in severe AS pain. If your doctor thinks you’re a candidate for hydrotherapy, they can recommend a physiotherapist for you.

5. Apply heat and cold therapy

Both heat and cold therapy may help relieve AS symptoms. According to the Arthritis Foundation, heat is good for relieving stiffness and soothing tired, strained muscles. Try a warm bath, or apply a dry or moist covered heating pad or hot water bottle to the painful area.

For acute or severe pain, cold may be the better option. Cold reduces blood flow and inflammation to help dull pain. It also calms nerve endings. A gel cold pack or a frozen bag of vegetables from your freezer work well for cold therapy.

Don’t use heat or cold therapy more than 20 minutes at a time.

6. Use orthotics for foot pain

With AS, much focus is placed on the back. But the feet are important too. Plantar fasciitis, an inflammation of the plantar fascia, is a common cause of severe pain. The plantar fascia is a ligament that runs between your heel and your toes.

Arch supports, known as orthotics, can help align your feet and distribute weight evenly. Your doctor may also prescribe a night splint to stretch your feet while you sleep. Orthotics may help other foot problems common to AS such as cramping, toe clawing, and Achilles tendinitis.

7. Think about complementary treatments

Acupuncture is a complementary treatment for pain. The therapy involves inserting needles into specific, imaginary lines on your skin known as meridians. Acupuncture may help your body release natural endorphins to ease pain. Other complementary treatments that may relieve pain are aromatherapy, mindfulness, and meditation.

Fight back against AS pain

AS pain can cause a range of emotions from frustration to helplessness. It’s important to keep your pain controlled. Medications are necessary for some people. Lifestyle changes and natural treatments may be enough for others. Wherever you fall on the treatment spectrum, it’s empowering to take steps to control pain. It’s a reminder that you’re in charge, not your pain.