Pain is actually the most important sense that allows a person to be aware of his or her own body. When something goes wrong in a person's body, when a disease or damage occurs, this usually makes itself felt as pain. The sensation of pain is really important, but people do not give the pain the importance it deserves, and sometimes they consult a doctor when the disease progresses or even when it is too late. Spinal pain, that is, back-waist-neck pain, are the pains we encounter most frequently in daily life and are also the ones that are most neglected with the mentality of "it will go away anyway". Some spinal pain may be mechanical and normal to some extent. For example, it is normal for a person's back to hurt after standing for too long. But it is not normal for the pain to start after standing for two minutes. The typical feature of mechanical pain is that they do not occur at rest. In other words, a person does not feel pain while resting in bed, but the pain begins when he does work or gets tired. Among spinal pains, the pains that should definitely be taken into consideration are night pains. If a person feels pain in bed at night and this pain wakes him up from his sleep, then something is wrong. This pain must be taken seriously. The most important night pains are cancer pains, but fortunately they are rare and occur in older ages. Especially bone and blood cancers, and cases where cancer spreads to the bone, may initially present as night pains. As the disease progresses, the pain spreads throughout the day and becomes continuous. The most common night pains we encounter are pains that usually occur in young and middle ages and increase towards the morning. If morning stiffness is added to this pain, the chance of having inflammatory spinal rheumatism, also known as ankylosing spondylitis, is very high. Ankylosing Spondylitis is a disabling disease that generally affects the spine and sometimes large joints such as hips and knees in addition to the spine. Over the years, it glues all the spinal bones together and bends the patient forward. Its most important feature is that it generally progresses very insidiously. The pain is very mild at first and gradually increases over the years. Spinal movements are gradually restricted. Since pain and limitation of movement progress very slowly, people do not pay much attention to this. So much so that sometimes when the patient enters the examination room door, We can diagnose disease by looking at the shape of the body, but the person is not yet aware of his disease. There are patients whose back hunchback and waist-neck movement limitation have increased and the diagnosis has been made even when they are approaching the final stages of the disease. Because of this insidious progression, the average time to diagnosis is 5 years after the first pain complaints begin. For this reason, patients with nighttime spine pain, which is the most important and early symptom of Ankylosing Spondylitis disease, and especially those who complain of morning stiffness along with this pain, should consult a doctor before it is too late. However, what we mean by the morning stiffness we are talking about here is not a waist-back stiffness that can occur every morning in normal people and lasts for a few minutes. In this disease, morning stiffness is the patient's inability to make spinal movements for at least 30 minutes (sometimes an hour or two) when he/she gets out of bed, and there is extreme stiffness around the spine. Generally, within a few hours, sometimes towards noon, this stiffness disappears and the patient begins to move normally. The next morning the same scenario is repeated. For this reason, people with prolonged morning stiffness in the waist-back area should consult a doctor as soon as possible. Medicine is no longer helpless in the treatment of ankylosing spondylitis as it was 15 years ago. Great progress has been made in the treatment of the disease in the last 10 years with new biological treatments. Resistant pain, which is the biggest problem of these patients and does not allow spinal movement, can now be controlled with these medications. The most important treatment to prevent restriction of spinal movements in ankylosing spondylitis is exercise, not medication. After the pain is corrected with medications, patients can prevent the bending of the spine by exercising regularly. But the real problem is diagnosing the disease early, and once the spine ossifies, neither medication nor exercise can fix this. That's why we say BEWARE of back pain at night and morning stiffness……
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