I’m losing sleep over back ache

Q I AM 78 and have recently been diagnosed as having ankylosing spondylitis. I am in constant pain and the only remedy I have been given is to regularly take painkillers in the form of codeine and paracetamol. I am trying not to take too many as I am concerned about the long-term effects. This is all worrying enough, but another concern is that the pain is interrupting my sleep, making me bad-tempered and irritable. Are there any other remedies that would help? A ANKYLOSING spondylitis (AS) is a significant diagnosis to receive at any age – it is usually diagnosed in young men.

It is a rheumatological condition causing an arthritis specifically of the spine and lower back joints with inflammation and fusion of the vertebrae.

The main feature of AS is back pain which is generally worse with rest – unlike a simple back pain which gets better with rest.

Patients will often describe being woken up at night by the pain, but it gets better with movement and exercise.

The other main feature of the condition is stiffness within the spine, particularly in the mornings.

Good pain relief is an essential part of the treatment. Paracetamol and codeine would not usually be the first choices, but rather antiinflammatory drugs (ibuprofen or naproxen) that target the inflammation as well as the pain.

These drugs may not be initiated in elderly patients due to the risks of bleeding; however it is always worth weighing up the risks and benefits of using anti-inflammatories, as the pain relief achieved may far outweigh any small risks.

Movement and exercise are another fundamental part of AS treatment and all patients should see a physiotherapist to learn the best techniques. Regular exercise can ease pain and slow the extent of any deformity that may ensue from the fusion of the vertebrae.

Referral to a specialist is important for patients newly diagnosed with AS, particularly in light of new treatments that are available.

New biological therapies have been shown to be very effective in AS, as with other rheumatological conditions, and this is certainly a discussion worth having.

When pain is bad enough to disturb sleep, it is imperative to find an answer as the knock-on effects of sleep deprivation will worsen the pain. It’s worth trying heat pads, a TENS machine or, in some cases, a specialist doctor can offer injections. A pain clinic referral from a GP may be necessary to find long-term solutions.

Q ABOUT a year ago after routine blood tests, my husband, who is in his mid-60s, was told he had ‘stage three chronic kidney disease’. His blood pressure was very high and he was prescribed statins for his cholesterol.

This all seemed very sudden as only a couple of years before, all was normal. The blood pressure is now controlled but we are rather left in the dark about the kidney disease and what this means.

I would so appreciate some information and advice. A CHRONIC kidney disease (CKD) is a newly described condition that has been widely diagnosed over the past few years. At least one person in ten in the UK has it, apparently.

It is actually relatively controversial among doctors, particularly GPs, who have seen a plethora of patients labelled with a disease which would in fact be more aptly named a ‘state’ or ‘concern’.

In essence, CKD means the kidneys are ageing and their functions of removing waste and regulating blood pressure are less efficient than before. It is a normal part of the ageing process, highlighted by the fact that it is seen in more than 50 per cent of people aged 75.

This ageing of the kidneys is seen earlier in those with certain conditions such as diabetes and high blood pressure.

The importance of CKD as a condition is not that there is kidney disease that requires treatment, but rather that scientific evidence shows it is a risk factor for other diseases, namely heart disease and strokes.

This is the fundamental reason why so many people are being told they have it: being aware of the higher risk from the CKD allows doctors to work together with patients to lower other risk factors such as cholesterol.

There are grades of the condition from one to five, and the majority of those diagnosed will have mild or moderate CKD – stage three – requiring annual monitoring from their doctor.

Calling it a disease has led to a great deal of anxiety among patients, especially as GPs don’t always have the time to explain the true nature of the condition.