Management of Chronic Low Back Pain in Ankylosing Spondylitis within the Framework of a Biopsychosocial Approach

Öz

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease affecting the spine, with chronic lower back pain being one of its most common manifestations. Although the disease has been addressed within a biomedical model for many years, current literature reveals that chronic pain is a multifaceted condition that cannot be explained solely by inflammation and structural damage. In this context, the biopsychosocial model is gaining more acceptance as a holistic approach to understanding the experience of chronic pain. The biopsychosocial model suggests that pain perception is influenced not only by biological processes but also by psychological factors and socio-environmental variables. In particular, central sensitization, neuroplasticity changes, and chronic inflammatory processes are key mechanisms explaining the chronicity of pain in AS. The aim of this review is to examine the effectiveness of physiotherapy-based interventions in chronic low back pain in AS by evaluating it within the framework of a biopsychosocial model. The literature shows that exercise-based approaches have significant effects on reducing pain intensity, increasing functional capacity, and improving quality of life. Furthermore, it is reported that psychological factors and individual patient characteristics influence treatment response, and therefore a multidisciplinary approach plays a role in clinical success.

Anahtar Kelimeler

• Ankylosing spondylitis
• chronic low back pain
• biopsychosocial model
• physiotherapy
• exercise

Etik Beyan

Since this study is a literature review, it does not require ethical committee approval.

Biyopsikososyal Yaklaşım Çerçevesinde Ankilozan Spondilitte Kronik Bel Ağrısı Yönetimi

Öz

Ankilozan Spondilit (AS), omurgayı tutan kronik inflamatuvar bir romatizmal hastalık olup en sık bulgularından biri kronik bel ağrısıdır. Hastalığın uzun yıllar biyomedikal model çerçevesinde ele alınmasına karşın, güncel literatür kronik ağrının yalnızca inflamasyon ve yapısal hasarla açıklanamayacak kadar çok boyutlu yapıya sahip olduğunu ortaya koymaktadır. Bu bağlamda biyopsikososyal model, kronik ağrı deneyiminin anlaşılmasında bütüncül bir yaklaşım olarak daha fazla kabul görmektedir. Biyopsikososyal model, ağrı algısının yalnızca biyolojik süreçlerden değil; aynı zamanda psikolojik faktörler ve sosyal çevresel değişkenlerden etkilendiğini ortaya koymaktadır. Özellikle santral sensitizasyon, nöroplastisite değişiklikleri ve kronik inflamatuvar süreçler, AS’de ağrının kronikleşmesini açıklayan temel mekanizmalardır. Bu derlemenin amacı, AS’de kronik bel ağrısını biyopsikososyal model çerçevesinde değerlendirerek fizyoterapi temelli müdahalelerin etkinliğini incelemektir. Literatür, egzersiz temelli yaklaşımların ağrı şiddetini azaltma, fonksiyonel kapasiteyi artırma ve yaşam kalitesini iyileştirme üzerinde anlamlı etkiler sağladığını göstermektedir. Ayrıca psikolojik faktörler ve bireysel hasta özelliklerinin tedavi yanıtını etkilediği ve bu nedenle multidisipliner yaklaşımın klinik başarıda rol oynadığı bildirilmektedir.

Anahtar Kelimeler

• Ankilozan spondilit
• kronik bel ağrısı
• biyopsikososyal model
• fizyoterapi
• egzersiz

Etik Beyan

Bu çalışma literatür derlemesi niteliğinde olduğundan etik kurul onayı gerektirmemektedir.

Kaynakça

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