Effectiveness of Cognitive Behavioral Therapy, Physical Therapy, and TNF Inhibitors in Managing Chronic Lower Back Pain in Ankylosing Spondylitis Patients

Abstract

Background: Background: Ankylosing Spondylitis is a chronic inflammatory condition of primarily the spine and causes immense pain and functional limitation. The current treatment with Tumor Necrosis Factor inhibitors is effective in controlling inflammation but does not provide a solution to the multi-dimensional aspects of the disease, which includes both chronic pain and psychological suffering.

Objective: This study attempted to evaluate the effectiveness of the combined treatment regime of TNF inhibitors, PT, and CBT in the management of chronic lower back pain, quality of life in patients with AS.

Methods: A clinical controlled randomized trial conducted on 45 AS patients and divided them randomly into three groups of 15 each: TNF inhibitors alone, combined PT and CBT, and all treatments combined. Collected data through Numeric Rating Scale (NRS), Bath Ankylosing Spondylitis Functional Index (BASFI), and the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire, also the estimation of biomarkers of inflammation CRP and ESR. The research was in compliance with the Declaration of Helsinki. The study obtained the consent of the institutional review board. Data were tabulated for analysis on SPSS Software Version 25. The same was computed by one way ANOVA, and chi-square were applied wherever necessary.

Results: Post-intervention, the group receiving all combined treatments showed a significant improvement in NRS (F-statistic: 12.362, p=0.000060), BASFI (F-statistic: 21.590, p=0.000036), and ASQoL (F-statistic: 44.499, p=0.000422). A statistically significant reduction of CRP (F-statistic: 26.

Conclusion: The combination of TNF inhibitors, PT, and CBT has significantly improved the treatment outcomes in patients diagnosed with AS. It was noted that a multidisciplinary approach was more effective in handling the complex symptoms of AS, like chronic lower back pain. The comprehensive care model ensures the physical symptoms are alongside the increase in quality of life.

Keywords: Ankylosing spondylitis, TNF inhibitors, Physical Therapy, Cognitive-Behavioral Therapy, chronic lower back pain, quality of life, inflammation biomarkers