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A prospective study has shown that ankylosing spondylitis (AS) patients often require narcotic analgesics to manage pain unresponsive to antiinflammatory therapies.
AS patients (n=706) were serially assessed (every 6 months) and outcome measures were collected, including disease activity and functional measures (BASDAI, BASFI), along with radiographic outcomes. Investigators specifically looked at opioid usage.
Factors significantly associated with opioids included longer disease duration, smoking, lack of exercise, higher disease activity (BASDAI) and functional impairment (BASFI), depression, radiographic severity, and cardiovascular disease.
Patients taking opioids were more likely to be using anxiolytic, hypnotic, antidepressant, and muscle relaxant medications.
It appears that subjective measures (depression, BASDAI, BASFI) moreso than objective measures (CRP, ESR), drive opioid use in AS.