Advice on dealing with flares please.

Posted , 12 users are following.

good morning to you all...My background details are as follows..diagnosed with PMR in November 2016.

My Pred dose started off at 15mg,no improvement,and was adjusted by the Rheumatologist to 30mg.He thought I wouldn't be able to drop below 5 mg,and told me to expect to be on Pred for 2 to 3 years.

By November 2017 I had reduced to 6 and experienced a mild flare.I increased to 7 1/2,no real effect,and consulted a nutrologist..she advise a low Histimine diet which has had a marvellous effect for me,and I have slowly reduced to 6 1/2mg. Her advice was if eating out,and unsure of any hidden ingredients to take an anti Histimine tablet beforehand as a precaution.It has worked wonderfully well.

Unfortunately and stupidly, I have shot myself in the foot,I took a friend out for a birthday lunch last Friday,and had forgotten to take my anti Histimine tablet.I tried to pick my way through an innocuous looking salad.I also had a bit of a struggle getting her wheelchair out of the back of my car,I have a slightly dodgy back.It wasn’t heavy just awkward...However the result is I now have a pretty horrid flare,with exhaustion.

I am in intense pain at night,all night,in left buttock traveling down left leg,I have increased my Pred from 61/2 to 71/2,with no effect.Last night the pain was severe at bedtime and I took my Pred dose 6 hours early increased to 10 mg.I had a slightly better night although not pain free.Is it a good idea to take it at night if your pain is almost exclusively at night?

In the early morning it is still there but I slowly potter about,then walk my dogs,do chickens and greenhouse etc,and it disappears,only to reappear in the evening before bed.How long before I feel the full benefits of an increased dose of Pred?

I am so pleased to be on this forum,it has been marvellously enlightening.I read the letters regularly and the factual and encouraging replies.I would be really grateful for any advice please.Oh forgot to mention ..I’m 76.

 

0 likes, 10 replies

10 Replies

  • Posted

    HI Fizzijam, Although you are very experienced in your polymyalgia pain ,the unilateral nature of your sciatica type pain may suggest the pain is originating from your back.It could be as simple as changing your mattress but worth getting your Gp to check your back for any disc or secondary osteoporosis from prednisolone, your dexa scan results could help with identifying this issue. 
    • Posted

      Handbrake..Heavens..thank you so much for your input..My focus from my back has shifted to my PMR.Will take action.
  • Posted

    "intense pain at night,all night,in left buttock traveling down left leg"

    I am not a doctor, but would make a guess that you have stressed your back and that is causing the pain.  PMR pain is usually symmetrical, not only on one side.  I would suggest that you see a doctor, but you can also try to use some over the counter  meds ( like ibuprofen) to help you with your back. Just be careful to not take it within a few hours  of your pred, since both can upset stomach. 

    Last thing is that you don't have a PMR flare and probably should go back to your original dose that managed PMR.

    • Posted

      A million thanks Nick....I have  absorbed your advice,and just phoned my lovely osteo who I have seen every three months for donkeys years ! He will see me tomorrow,he says it sounds like sciatica.Can’t take ibuprofen anymore darn it.My liver reacted badly to Diclofenic and the Rheumatologist advised no more anti inflammatories.

      thank you again😊

       

  • Posted

    I know you probably do this already but I have a microwaveable wrap which can be tucked round my back or round my shoulders if my neck or shoulders start to ache. It’s very soothing. You can get them from Boots and it saves a packet on the heat wraps! I do hope you get this sorted out Nd agree with the others that this doesn’t sound like a flare. 
    • Posted

      This is wonderful advice,and it has been part of my armory for my back for years! Thank you so much Celia.
  • Posted

    Fizzyjam I'm afraid to tell you this but I think you're looking at a back injury. I don't think this has anything to do with PMR. I do speak with some experience as I have had chronic lower back pain for 11 years. You really should see a doctor about it. Judging from the fact that you have pain traveling down your leg I'm also going to guess that you probably have a pinched sciatic nerve. Those can be quite painful. Gabapentin or pregablin are two medications they give for neuropathy which is what's happening to your leg. I would continue on your regular prednisone dosage as you go but put ice on your back rather than heat because this is a new injury and you want to reduce the inflammation which is something ice will do. Heat relaxes the muscles but your first concern is reducing the inflammation in your back. You might also want to try taking some ibuprofen or noroxin because both of those will help with the inflammation. And of course the prednisone helps too.

    A doctor will probably start out with an x-ray of your lower back. From this he can only see the vertebrae. He will not be able to see the discs in your back. The disks are a jelly like donut that sits between the vertebrae giving them cushion. When one of these discs breaks open and seep out that reduces the amount of cushion between the two vertebrae causing pain. In addition when the disc bulges it can press on a nerve most of the time it's the sciatic nerve. This then causes the pain to travel down the leg. However if it's not the sciatic nerve being pinched it could be another nerve as there are many in your back. The pain may radiate around to your hips. If your pain continues they may want to do an MRI of your lower back. An MRI will show soft tissue damage such as the discs. I wish you luck on this and hope that your back pain gets better and you don't have to deal with this again.

    • Posted

      Thankyou Amkoffee for taking the trouble to write in such detail.I have seen my osteo today.After checking me he says it is sciatica but thankfully he thinks it is not serious,and worked on me for half an hour.Glad to say I feel suitably loosened! He suggested I phone my GP to see if he could suggest an effective painkiller for nighttime that I don’t react to.

      My GP thought Diazapan would help relax the muscles,together with paracetamol,which hasn’t had any effect so far,but I shall try them both tonight,and sleep in a chair if necessary.

      many thanks for your time and trouble.😊

  • Posted

    That sounds like sciatica due to back muscles spasming because you over loaded them - that's what happens to me. I do an awkward movement to lift or pull something and wham!

    I don't think the pred will "cure" it but myofascial pain syndrome is a common cause of such problems and that IS helped by pred as it is caused by the same inflammatory substances as PMR. In the meantime, warmth or ice may help - everyone is different. Ice doesn't help me, it makes the muscles spasm even more. 

    • Posted

      You’ve got it in one Eileen! My osteo agrees with you.Hopefully the advice and treatment he gave me will work.He has worked miracles with me in the past!  Thankyou for the tip re warmth or ice..ice doesn’t help me either..I have an electric under blanket which can be bliss,and micro wave wheat bags for downstairs.

      Thank you again for coming to the rescue!

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