My life was wrecked by chronic pain. The answer was a 10p pill - but doctors didn't give it to me for three years. Here's the reason why that you MUST be aware of: ETHAN ENNALS

The pain was paralysing and inescapable. As I lay, crumpled on the floor wearing one half-tied shoe, I realised that, once again, I wasn’t going to be able to make it into work.

The agonising burning sensation was coming from the exact spot it had done for the past year-and-a-half: a line of muscle at the left side of my lower back – just above the hip bone.

At all times, it felt as though it was being squeezed between two hot metal tongs.

It intensified the more I tried to do. And, when I pushed it too far, I would suffer severe flare-ups which would leave me breathless, nauseous and unable to leave the house for days.

That was April last year, my lowest point. A recent trip to a new physiotherapist – the latest in a long series of health professionals I’d sought out in desperation and at great cost – had made things even worse, to the point that I was now writhing in pain, half-dressed on my living-room floor.

In desperation I rang my GP practice seeking help. When I finally got through the response from the doctor was brutal.

I explained I couldn’t move for the pain and that I was at the point of being unable to physically get into work. ‘According to your records, you’ve already had a scan which showed nothing,’ the GP cooly responded. ‘I can’t send you for another one unless it’s a new problem. They aren’t cheap.’

I felt the inference was that I was imagining it. I lost my temper in frustration.

‘You sound very angry Ethan,’ the GP responded. ‘Why is that?’

‘Because,’ I said through gritted teeth. ‘I’ve been living in pain for nearly two years, my life has been completely turned upside down, and no one can, or seems to want to, help me.’

I wasn’t alone, of course. More than one million people in the UK are currently signed off work, long-term because of back or neck pain that cannot be remedied.

Had I not been a health journalist, I might have ended up in the same boat. But, at the age of 27, I was determined to get to the root of the problem. And today, a year and one new GP later, I can now report that taking a 10p-a-day prescription pain medication has turned my life around.

There have been some setbacks, but I’m beginning once again to live a normal life. So why did it take nearly three years for my symptoms to be taken seriously?

It had all started in 2022, when at the age of 25, training for a half-marathon, I suddenly felt a searing pain in my left hip on a run alongside the Thames river.

I dismissed it as a tiny injury, stopped running and got the bus home. But as the weeks progressed, I realised that the discomfort was not going away.

Any physical activity would be followed by days of agony. I started to develop other unexplained symptoms, including severe back pain, which stopped me sleeping. I developed a swollen ankle so sensitive to the touch that I gave up wearing smart shoes and lived in my trainers (it was the only wear they got, as by this point I’d quit exercise completely). My GP referred me to a physiotherapist, who after a two-month wait simply suggested taking shorter runs.

An MRI showed no signs of damage in my back or hip. And still the pain got worse.

A stream of bank balance-sapping private physiotherapists and osteopaths (non-medics who help with pain problems) followed, each of whom confidently offered a different diagnosis and new treatment plan, involving various stretches and exercises which proved useless.

Their explanations for my pain though were entertaining: one of my legs was slightly shorter than the other; I was sleeping on my front; I was storing up work-related stress in my back; and, particularly memorably, it was a manifestation of repressed childhood trauma.

As this process rumbled on, the pain had a massive impact on my quality of life.

My back pain meant that I rarely got a full night’s sleep, meaning I was constantly tired.

My social life suffered. After suffering several debilitating flare-ups while out, I became anxious about leaving the house for too long.

So I started making excuses to skip birthdays and celebrations.

Work became a struggle. Weighed down by the pain, I found it difficult to make it through a full week in the office. I was living on over-the-counter pain medication.

I had pretty much lost all hope when a random suggestion from a physiotherapist that perhaps I should see a rheumatologist (a specialist in diseases of the joints, muscles and bones) began the turnaround. And so I returned again to my GP practice to beg for another referral, this time to a rheumatologist. Thankfully, she agreed.

Finally, after half a year of waiting – and nearly two years from when my hip pain first began – I saw a specialist at my local north London hospital in May 2024.

It took her just five minutes to diagnose me. She asked me a series of questions.

Was the pain in my lower back and buttocks? Did it wake me up at night? Was the pain typically at its worst in the morning, but tended to improve during the day?

To each question, my answer was the same: yes.

‘Well I think it’s pretty clear what the problem is,’ she said, looking up from her computer. ‘You have axial spondyloarthritis.’

The condition was certainly a mouthful, but it wasn’t the first time I’d heard of it. In fact, I’d written about it before, but I’d never associated the condition with my own symptoms.

Axial spondyloarthritis is a form of inflammatory arthritis which tends to affect the spine and surrounding joints. Around 200,000 people in the UK are thought to have the condition.

Sometimes it can also inflame joints elsewhere in the body, like the foot. The symptoms usually appear in young people, more often men, under the age of 45.

The cause is unknown, but many cases are thought to be genetic, meaning it is passed down through family members. Over time, axial spondyloarthritis can be disabling as it can cause bones in the spine to fuse together.

Until recently, this fusing of the bones was a distinct condition called ankylosing spondylitis. However, in 2024, this term was discarded as doctors argued it created a false belief that ankylosing spondylitis was a more severe disease, rather than the advanced form of axial spondyloarthritis.

Crucially, in its early stages, the condition often does not show up on scans, making it exceedingly difficult to diagnose.

I knew all this, but, bizarrely, at no point had I considered it might be the problem. Nonetheless, as strange as it might sound, I was elated to finally have some kind of diagnosis for the pain, because I’d begun to think I was going mad.

My doctor explained that there were several drugs which could significantly reduce the symptoms. The first, adalimumab, known by brand name Humira, is the most commonly prescribed. The £750-a-jab medicine reduces the production of proteins in the body linked to inflammation (see panel below).

Three months later, I began on twice-monthly injections, which I keep in my fridge. I was warned that, for many patients, it can take months for any change in symptoms to occur.

But I noticed a difference in less than two weeks. The debilitating swelling in my left heel began to go down. My back pain began to ease. I was no longer waking in the night with pain.

This was a relief. But one major problem remained. The worst pain – the one in my hip – was still not going away.

This necessitated yet another visit to the rheumatologist, who explained that what I was experiencing was likely a chronic pain cycle, one in which the body wrongly believes it is still injured and continues to send out pain signals to the brain.

My doctor said she was confident that, eventually, the pain would go. But she added this could be in a matter of weeks or it could even be years.

And, in the meantime, there were no extra drugs that she had to offer me to help.

As more time passed, and the pain continued, I began to wonder whether I would ever get better. I felt helpless, hopeless and I knew that I was becoming depressed.

Reluctantly, I decided to see my GP about taking a short course of antidepressants.

It was at this point that fate seemed to step in. I got lucky and saw a different GP that day who explained that given my symptoms he did not think the standard issue mood-boosting antidepressants, selective serotonin reuptake inhibitors (SSRIs), were right for me.

Instead, he believed I would benefit most from a type of antidepressant called tricyclics. These drugs, which include amitriptyline and nortriptyline, were used as early as the 1950s to treat depression.

With the advent of SSRIs, tricyclics fell out of favour. However, today they are increasingly being used to treat the type of chronic pain I was experiencing, after researchers recognised that some sufferers experienced a significant reduction in their pain symptoms.

It’s still unclear why they work in this way, but one theory is that they suppress pain signals sent via the nerves to the brain.

My GP wrote me a prescription for nortriptyline and warned that it could take several months before I felt any effect, if at all.

It’s fair to say that I had low expectations. When I began the treatment, I also struggled with bouts of drowsiness and had terrible dry mouth. However, I did what I was told and stuck with the pills. And, slowly, I began to notice a difference.

At first, the changes were small. I didn’t ache as much at the end of the work day. I didn’t get a sharp throbbing pain if I climbed a flight of stairs too quickly.

But, at the beginning of this year, I realised I had gone weeks without a flare-up. Cautiously, I started to push my body. I began swimming – initially for just ten minutes at a time. I also got back into lifting weights at the gym.

Each time that I would finish these sessions, I would steel myself for a flare-up. But the pain explosion never came.

It was as though the nortriptyline had turned down the dial on my pain, just enough for me to push through. Today, I’m back to running, swimming and working out in the gym, and my pain – while still there in the background – is manageable.

All told, the impact of the nortriptyline combined with the adalimumab has been miraculous.

It worries me that had I not had the energy and determination to keep trying to solve the mystery of my own pain, I too might have been signed off work and given in to living a life blighted by pain.

Where might I be now if I hadn’t pushed to be referred to see a rheumatologist or returned to my GP to ask about antidepressants?

Read More

Charities say that it is all-too common for arthritis patients to have to self-advocate in this way.

Axial spondyloarthritis patients wait, on average, seven-and-a-half years to be diagnosed, meaning I was one of the lucky ones.

Back pain patients are twice as likely to have depression, anxiety, psychosis and sleep deprivation, than the average population. A fifth of long-term pain sufferers consider suicide and as many as 14 per cent will attempt to end their lives. Like so many of the problems facing the NHS, there is no easy solution to the number of people in the UK living in pain.

However, I think doctors need to reconsider how they handle the medical problems of young men.

Of course, there is good evidence that women’s pain problems – such as those triggered by endometriosis – are all-too-often dismissed.

But it’s also undeniable that men have significantly worse health outcomes than women. Men are twice as likely as women to die prematurely of cardiovascular disease, lung cancer and liver disease. Three out of four suicides are men, suggesting they receive inadequate mental health care in the UK.

It’s a big enough problem that, last month, the Government announced its first ever men’s health strategy, a plan designed to tackle the life expectancy gap between men and women. This gap has long been explained by the well-worn line that men put off seeing a doctor about worrying symptoms until it is too late. But I am not sure this totally explains it. I sought help as soon as I could.

Yet I wasn’t rewarded for being proactive. Instead I was brushed off by doctors and physios who believed I was making an unnecessary fuss over a sports injury.

The fact that axial spondyloarthritis patients – two-thirds of whom are men – wait so many years for a diagnosis suggests I cannot be the only person to have had this experience.

Could it be that the belief among GPs that men will only see a clinician when their health has completely deteriorated means that seemingly fit and well men like myself are not taken seriously when we do arrive at their practice?

One thing is for certain: ensuring GPs are better educated about the symptoms of inflammatory conditions, such as axial spondyloarthritis, would be a move in the right direction.

If the first GP I’d seen in 2022 had referred me to a rheumatologist, then I could have begun treatment far sooner.

And, experts agree, more patients should be offered tricyclic tablets like nortriptyline and amitriptyline.

They won’t work for everyone, but, for some, like me, they can be life-changing.

There were two medicines that helped combat my axial spondyloarthritis symptoms.

One was the daily 10p tablet nortriptyline, which reduces pain signals in the brain. The other is the £750-a-jab arthritis drug adalimumab, also known as Humira. The twice-a-month injection is known as a biologic drug because it targets inflammatory molecules in the body.

In the case of adalimumab, these molecules are damaging proteins called tumour necrosis factor, or TNF.

However, due to its cost the NHS also offers alternative treatments. These ‘biosimilar’ medicines do not contain exactly the same compound, making them cheaper.Biosimilars for adalimumab include Yuflyma and Imraldi. These medicines tend to cost around £320-a-jab.

For many arthritis patients anti-TNF drugs can, over time, become ineffective as the body develops defensive antibody cells which attack the medicine. Patients are then placed on a new injection.

• Are you a man whose pain has been dismissed?
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