Beyond Inflammation: Nociplastic Pain as a Contributor to Chronic Pain in Ankylosing Spondylitis: A Case Report

The term nociplastic pain (NP) was adopted by the International Association for the Study of Pain very recently, in 2017, defined as “pain that arises from altered nociception not fully explained by nociceptive or neuropathic pain mechanisms.” The medical field is well-versed with the terms nociceptive and neuropathic pain, but the concept of NP is still lacking. This unfamiliarity with the term and condition is commonly a contributing factor to prolonged patient suffering. Here, we present a case of a 49-year-old male who presented with upper back and neck pain for 8 years with a Numeric Rating Scale (NRS) score of 8–9 and was diagnosed with a case of ankylosing spondylitis (AS) on polypharmacy, which he continued taking for 1.5 years but stopped eventually, due to having no pain relief. On eliciting further history and examination, a diagnosis of AS with probable NP was made as patient fulfilled all the four4 criteria as follows: (1) pain >3 months, (2) distribution of pain multifocal and widespread (occipital, both shoulder and lower back), (3) pain not explained by nociceptive or neuropathic mechanisms, and (4) sign of hyperalgesia in the pain region was noted. An interdisciplinary approach was used; combination therapy for AS and NP component with medication, exercises, and psychotherapy, after which the NRS scores decreased to 4–5. Early recognition of NP is essential to prevent misdiagnosis and prolonged suffering, especially in chronic pain conditions like AS. This case highlights the importance of identifying nociplastic features and initiating targeted therapy, which significantly improves pain outcomes when conventional treatments fail.