Background. Ankylosing spondylitis (AS) is a systemic inflammatory disease with chronic back pain as the most common presenting symptom. We present a case of a male patient with AS reporting symptoms of severe low back pain, buttock pain, and limited spinal mobility. After chronic treatment with opioids, we administered pregabalin at a dose of 300？mg as an analgesic agent while opioids were discontinued. Findings. Pain symptoms improved progressively, and opioids were gradually discontinued without any withdrawal symptoms reported. Conclusions. Pregabalin is potentially useful in the management of pain in patients with AS while effectively managing the discontinuation of opioid treatment. 1. Introduction Ankylosing spondylitis (AS) is a systemic inflammatory disease of unknown origin that affects predominantly, but not exclusively, male individuals. Chronic inflammatory back pain is the most common presenting symptom and typically develops between the ages of 20 and 40. Alternating buttock pain caused by sacroiliitis is a less frequent presenting symptom but is often regarded as a classic initial indication of the disease [1]. Management of AS is based on both nonpharmacological and pharmacological treatment options [2]. Nonpharmacological treatments include education, exercise, physiotherapy, and surgical interventions. Pharmacological agents used in the treatment of AS involve nonsteroidal anti-inflammatory drugs (NSAIDs, conventional ones and coxibs), disease modifying antirheumatic drugs such as sulphasalazine and methotrexate, biological agents such as etanercept and infliximab, steroids (local and systemic), and analgesics. Opioid analgesics, in particular, might be considered for pain control in AS patients in whom NSAIDS are inefficient, contraindicated, and/or poorly tolerated [3]. A number of anticonvulsants are effective for chronic pain therapy, particularly for lancinating pain [4]. Phenytoin, carbamazepine, oxcarbazepine, valproic acid, and clonazepam, as well as the newer agents, gabapentin and pregabalin, have been used frequently with impressive results. Pregabalin, like gabapentin, was shown to be effective in several forms of neuropathic pain, incisional injury, inflammatory injury, and formalin-induced injury. [5–7]. We present a case in which pregabalin was reported effective in a male patient with AS suffering from opioid-refractory pain. 2. Case Presentation Mr. A. was a 72-year-old male patient with AS, reporting symptoms of low back pain, buttock pain, shoulder pain, arthralgias, and limited spinal mobility. The intensity of the
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