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A New Life for My Patient with Ankylosing Spondylitis

I am a rheumatologist. Most of my patients live with pain, they suffer from diseases in joints (osteoarthritis, rheumatoid arthritis, psoriatic arthritis, gout, spondyloarthritis) and periarticular structures (enthesitis, tendinitis), also systemic connective tissue diseases: lupus, polymyositis, systemic vasculitis, rheumatic polymyalgia, and others. Chronic pain is one of the central facets of rheumatology, and joint pain is the most common symptom. To treat pain, we use non-steroidal anti-inflammatory drugs, hormone therapy, pills, and injections. Alongside, physiotherapy and physical exercises are added. This helps some of my patients feel better, but some don’t progress.

In my training, we studied the literature about different diseases, their mechanisms, therapy, and outcomes. Even as a clinician, I continue to do that to provide the best care to my patients. I’ve also done research to analyze the side effects of therapy and ways to minimize them. I see different people and find different opportunities to help them, but for some, medical care makes sense, for others, it doesn’t work.

To treat the pain, we try different drugs, therapies, and combinations, but most patients don’t get better. The question of “why” keeps me up at night.

I want to share with you the story of one patient who came to me after suffering from pain for 7 years. He has an autoimmune condition called Ankylosing Spondylitis, which manifests by progressive inflammation of the intervertebral joints. At age 35, he started to feel pain in his back, then it affected his thoracic spine, and after a few years, his whole spine was involved. He’s been on medication every day to relieve the symptoms. Even still, every movement he takes hurts. His ongoing pain has led to depression, and over the years, he’s tried different drugs, gone to psychologists, physiotherapists, and rehabilitators, and used acupuncture and osteopathy. Physical activity was helpful, but he couldn’t do exercises through pain, and he became afraid to move. After our third visit, he told me about an app he downloaded called Menda. This was the first time I’d heard of it and I was so impressed when he came back in 6 months. Instead of a hunched, exhausted man, I met a healthy man with a straight posture and a wide smile. He came to say “thank you” for the application that changed his life. I don’t know if he has a wife or kids if he likes cycling or swimming if he dreams about Everest hiking or deep dives. Anyway now he has the opportunity to do all of this.

Honestly, I couldn’t believe the result. We had tried different methods and no one helped, so could an app change his outcome? How can training one’s brain affect such severe pain? When you see the result with your own eyes, the miracle (I'm not afraid to say this word), all my skepticism is gone. I was amazed and started to learn more about modern research. Scientists understand that pain that accompanies rheumatic diseases is the result of the action of pathological stimuli caused by damage to the tissues of the musculoskeletal system and the activation of neurogenic (caused or controlled by the Nervous System) mechanisms. The presence of multiple mechanisms that continue pain necessitates multi-modal therapy targeting different parts of the pathology. One of the challenges in developing effective pain therapy is the individual’s brain and nervous system's response to the pain (variability in pain perception, propensity to form chronic pain, and response to therapy).

With the accumulation of scientific information, there is a constant update of views on the nature of pain and methods for their correction. Pain reprocessing therapy is an evidence-based treatment for chronic pain that aims to create new neural pathways in the brain to eliminate pain. We can break the pathological circle of pain’s reproduction. The harmonious interaction of body and brain provides a high standard of living. We can use this interaction to change our perception of pain and the brain restores the body.

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