Inflammatory back pain

Do I have inflammatory back pain?

Have you got the S factor posterYou may have inflammatory back pain if you answer yes to at least 4 of the 5 of the statements below.

Back pain of more than 3 months duration is inflammatory if:

  • Age at onset less than 40 years
  • The pain started slowly
  • Improvement with exercise
  • No improvement with rest
  • Pain at night (with improvement on getting up)

What is inflammatory back pain?

Back pain is very common but in most cases the pain is said to be ‘mechanical' - that is, related to the way the muscles, ligaments, discs and bones work together.  For a small number of people, the pain is due to inflammation in the back. 

It is important to be able to distinguish inflammatory pain from mechanical pain, as the treatment is different.

What are the symptoms of inflammatory back pain?

Typically, inflammatory back pain:

  • Starts before the age of 40 years
  • Has been present for at least 3 months
  • Has come on slowly over time
  • Is worse in the mornings
  • Causes stiffness in the mornings lasting for at least 30 minutes (stiffness is perhaps best described as the sort of aching you get the day after heavy exercise)
  • Improves with exercise, and is worse with rest
  • Improves with anti-inflammatory drugs (e.g. ibuprofen)
  • Can wake people from sleep, often in the second half of the night
  • Can often cause pain in the buttocks, but rarely pain shooting down the leg (sciatica)


Inflammatory back pain is the main symptom of a group of conditions called spondyloarthritis (SpA).  You might also hear the term axial SpA which means inflammatory arthritis of the spine.

SpA affect the spine, joints, tendons, ligaments and occasionally the internal organs, and they can be associated with other conditions, particularly psoriasis (a scaly skin rash), inflammatory bowel disease (Crohn's disease and ulcerative colitis) and uveitis or iritis (inflammation of the eye). 

What should I do?

SpA can be difficult to diagnose so NASS strongly  recommend that all patients with inflammatory back pain are referred by their GP to a rheumatologist for assessment.

Next steps to diagnosis.

What treatments are available for inflammatory back pain?

It is managed through a combination of pain relief and exercise.

Will changing my lifestyle help?

The two most important changes you can make is to start exercising and to stop smoking. There is little proof that changing your diet will help.

Last reviewed: February 2014