Dear LC,
Mine is also Spondyloarthritis, and I can tell you that I cannot tolerate cold on it at all, but that said, my DC has told me that if nothing else works, 10 minutes of heat followed by 10 minutes of ice will. Well, I thought this such an inadequate an answer, but it really did help me! I cannot take the ice alone though, no way!
The arthritis exercises at the Y helped me for awhile, I even started taking swimming lessons, and I loved it, felt pretty well, finally the coldness of the water crashed me beyond belief. I picked myself up after a while, went back to just the classes, those are in warmer water, but the temp was not consistently warm enough, and I was having those severe muscle attacks, the Rheumy said no more pool for now, that was quite a while ago. Plus I have Raynaud's so cold is my enemy.
Now to X-rays. Funny how you always have to keep going back for more, and different ones. I understand that they are looking for disease progression, but I started with complete back and neck MRI, thought I would die from laying flat on the table all that time. It showed very little, bulging disc, facet problems. X-rayed by surgeons was by 3 top notch Docs told that surgery would only ever make me worse. My GP and DC go over MRI and see the curvature of the tail bone, that was never mentioned, that I can find, nor was the SI joint damage until the Rheumy does X-ray. Myleogram which was like getting rear-ended all over again readings were basically no help, and I could not stand up straight for months after that. Myleogram came before second Rheumy who diagnosed me, though my GP was well on the way by then.
I have learned to take the films to the GP, DC, and whoever else will look at them because there are things that are not found or not mentioned, ESPECIALLY if they are not asked to be looked for, so I would start by looking at the tests that have already been done, because your answer could have very well been there all along!
I have learned that it does not take severe damage to cause severe pain, and it can be a lot of mild or moderate problems that can add up to one large pain in the back!
Sorry if this seems tangled up, I have been through this for 7 years, just to get a diagnosis, because I should have gotten over the car accident, been to several University hospitals for many of these tests and exams.
My back was always so bad, no one ever noticed how bad my knee, ankle and foot are on my left side, assumed it to be sciatica causing the pronounced limp, and drop foot, until my current Rheumatologist saw me and he caught it right away, but did X-ray those along with the SI joint, and there it was, plain even to me! I yelled about the worst pain, which was/is my back.
I am getting to the point where I can barely stand to lay on my back or my sides, may have to eventually rig up something like a chiropractic table to sleep, but strangely enough it is easier to lie on my back, as bad as it hurts, because too much side laying will tilt my pelvis, oh, you talk about pain!!!!!!!!!!! Only a DC can straighten that.
Not everyone reacts the same, you could be in the minuscule minority as to needing ice opposed to heat, or there may be something that is more prominent than the SI joint, and it could already be on an x-ray from your past. $6,000.00, that is a whole lot of money!
My Rheumy looked at all the x-ray reports, but he knew what was wrong with me before he even looked at me, I was required to fill out an in-depth questionnaire along with records from my GP and DC. By the way, I do not have psoriasis, did not know my Grandmother did until after I saw him, so he had no family history of RA to go on.
Chiropractor, he was the very first one I screamed for at the car accident, had to go to hospital for x-rays before he could touch me, NOTHING FOUND, was released, next day to the DC, we have decided that much of my pain is from the tailbone, and his adjustments are the only thing that will help that, I simply tell him to "put his foot into me" and he knows what to do. When that finally moves it has the kick of a firing a cheap shotgun!!! The release of pressure is astounding, the relief immediate! This curvature showed up on a regular x-ray, this curvature will continue to progress and could be a big factor.
LC, I am not a Doctor, Nurse or any type of medical professional, so I can only share what I have learned about myself and the process, so by all means listen to your Dr, if you trust him, just ask if a less expensive test can give you the answers to this, and have him or someone take a look at any done in the past.
Most of us also have Fibromyalgia, and I know a few women with this who can only tolerate cold baths, showers and ice packs. Just as the Rheumy told me "FM is a condition, not a disease, it is caused by chronic pain, it changes the brain, you have to get to the cause of the pain".
I can only wish you well.
SK
PS I feel as though I have a good start to my memoirs in just a few short days of finding your site!