AS Pain Linked With Depression, Anxiety, Stress, Study Finds

People with ankylosing spondylitis (AS) often endure considerable psychological distress — including depression, anxiety, and stress — that is related to their experience of pain, a study shows.

These findings highlight a need for more mental health resources for people with this disorder, the researchers said.

The study, “Ankylosing spondylitis and undifferentiated spondyloarthritis: The relationship between living with these diseases and psychological well‐being,” was published in the journal Musculoskeletal Care.

Research on ankylosing spondylitis and other rheumatic diseases tends to focus on the physical impact of these conditions on the body. In contrast, the emotional and psychological impacts of AS are rarely addressed in scientific studies. Even when studies do assess factors such as quality of life, they usually focus on how the disease affects a person’s ability to do physical tasks, not the emotional toll the disorder can take on patients.

Now, Kate Kelly, PhD, a researcher and teaching scholar from Victoria University, in Australia, sought to investigate the link between patients’ experiences with pain and their psychological state by surveying 161 people with AS and undifferentiated spondyloarthritis. People with this disorder have ankylosing spondylitis-like symptoms, but without all the clinical criteria required for a formal diagnosis.

The survey involved 135 people with AS and 26 people with spondyloarthritis. The age of respondents ranged from 21 to 72 years; 42 respondents identified as male and 112 as female (two preferred not to respond).

The average diagnostic delay — that is, the time between the first medical appointment and getting a disease diagnosis — as reported by respondents was nearly nine years, which is in line with previous research.

The respondents were asked to rate their pain, using the Brief Pain Inventory (BPI), over the past day and the past week. The BPI measures pain intensity on a scale from one to 10, where higher scores mean more pain.

On average, the participants reported pain scores of 4.26 for the past day and 4.48 for the past week. They also reported their highest pain level experienced in both timeframes: on average, 5.5 for the past day and 6.49 for the past week.

The BPI also measures (again on a scale from one to 10) the extent to which pain interferes with various aspects of daily life, including sleep, mood, walking ability, relationships, and work. Across these measurements, the average scores — both over the past day and over the past week — were around five or higher, indicating substantial impairment from pain.

“While literature highlights that pain associated with the conditions can vary from day to day, with periods of ‘intense’ pain being described as a flare … the data here highlight the significance and the persistence of the pain individuals are living with,” Kelly wrote.

Respondents also completed the Depression, Anxiety and Stress Scale Short Form‐21 (DASS). By comparing against normative values, DASS scores can be categorized as “normal,” “mild,” “moderate,” “severe,” or “extremely severe” for depression, anxiety, and stress.

The average DASS scores for depression and anxiety fell into the “extremely severe” category, while average DASS scores for stress were “severe.”

“This indicates that in general the participants in this study are experiencing high levels of psychological distress,” Kelly wrote. The scientist added that, in an average population sample, less than 5% of respondents would be expected to fall into the “extremely severe” category for anxiety and depression.

The results also showed significant correlations between pain intensity/interference and DASS scores — that is, people who reported higher pain or a greater interference in daily activities were more likely to also report higher depression, anxiety, and stress.

While the data do not directly show that pain causes these psychological problems, the scientist suggested that, at the very least, it is likely a contributing factor: “Living with chronic, consistent pain that an individual knows could get worse at any time, can foster anxiety in itself.”

“These thoughts could, however, have a compounding effect whereby an individual stops engaging in many daily activities out of fear that their pain will get worse, but then experiences depressive thoughts, due to the isolation and loss of experiences this may bring,” Kelly wrote.

Overall, the findings indicate that ankylosing spondylitis takes a toll on a person’s mental health. As such, psychological support should be made available for people with this and other rheumatological diseases, the scientist added.