1. Community
  2. Bones, joints and muscles
  3. Polymyalgia Rheumatica and GCA

Back pain with PMR

Posted , 7 users are following.

amkoffee
amkoffee

I have had back pain for 10 years before I got PMR. I assumed that once I started on pred that my back would improve but it's done just the opposite. It is worse then ever. The rheumatologist took an X-ray and said I have arthritis in my SI joint. I also have arthritis in my facet joints according to my pain management doctor.

So my question is do you think that PMR is causing this pain? I first started out at 15 mg and that just wasn't enough so we upped it to 20 mg for two weeks. Then dropped down to 15 mg for two weeks and then 12.5 for two weeks, and finally I'm on 10 mg for four weeks. I know alot of you will say that that is dropping to fast and I know it is but I did what the doc said to do not really knowing any better at the time. I never had any relief from back pain on the, 20 mg so I don't think preds going to work for that.

0 likes, 14 replies

14 Replies

  • faye______00403
    faye______00403 amkoffee

    Posted

    I've got a lot of arthritis pain in assorted joints.   It's hard to know which pain

    is PMR and which is arthritis.    Pred doesn't help arthritic pain.    I've been

    on pred about 2 and a half years and still don't always know.    A short time

    ago I had some breathing issues and my doc increased pred for several days.

    I tried to understand which part kept hurting and guessing that was not PMR.

    I will be 80 my next birthday so  know some of my pain is caused by the

    aging process.   Unfortunately 

  • mphooey
    mphooey amkoffee

    Posted

    I started having back pain in the spring and it increased over the months. Upping the pred seemed to help, but later I had an Xray which the rheum said showed a compression fracture of thoracic spine. We think long term use of pred brought on osteoporosis. So now I am in a bind. I am reducing my pred slowly and am now on 5 mg. Back hurts in the AM, is reduced by PM.

    Still awaiting treatment.

  • EileenH
    EileenH amkoffee

    Posted

    No - I have back pain that is due to muscle spasm that was slightly improved but not until after months on 15mg or so. It was the pain clinic specialist who identified it as myofascial pain syndrome which was causing my back muscles to get tight and they were as hard as floorboards! Eventually they would go into spasm and make the sacroiliac problems even worse - which on one occasion landed me in hospital and that was how it was all identified.

    The pain specialist worked on the tight muscles and the trigger points that myofascial pain syndrome leads to - they form in pairs on either side of the spine, in the shoulder muscles, about rib level and in the lower back, about where the baby's dimples are lol (doesn't have to be all 3 levels). They can be felt as hard knots of muscle fibres which are concentrations of the same cytokines that cause the problems in PMR. That's why a long time at higher doses MAY help them - but sometimes they are so established the effect of oral pred is minimal. Mine was also aggravated by a wisdom tooth that was growing in crooked - things have been a lot better since it was removed. But all sorts of things may contribute; one leg longer than the other, if your spine is curved in the wrong way, muscle groups that are not quite right.

    I'd had it for years too - and kept upright due to the ministrations of my osteopath and a Bowen therapist and weekly sessions of Pilates. All changed when I moved here - none of those are real options any more! But the local pain clinic was brilliant 4 years ago and really sorted it out with steroid injections into the trigger points, manual mobilisation of them and a technique called needling. But it  still took several months to really get a decent result.

    As your pain management doctor about spasmed muscles - they should recognise it. A local private orthopaedic specialist here didn't - the guys at the hospital were much better.

    • ricky23486
      ricky23486 EileenH

      Posted

      Eileen - yours is a very important and informative post .  As a manual therapist (not touting for clients as I live several thousands of miles away from you all!) working with myofascial pain syndrome, trigger points, chronic pain and soft tissue problems , I would agree that from my experience  the treatment techniques suggested by Eileen  can be very effective indeed.   In addition to Bowen there is also ( in the USA)  Crossfiber Corrective Muscle Therapy  as well as Pfrimmer Deep Muscle Therapy.  In the UK there are highly trained and qualified Medical Massage therapists specialising in tender and trigger point release and Myofascial Release.  Because it is invasive, dry needling is usually administered by  physicians working according to the  guidelines proposed and researched  by Dr Janet Travell.     Trigger points can also result from misuse, overuse or abuse of our bodies (of which we are all guilty!) and can cause really severe and often debilitating, radiated pain. Deactivation of trigger points either manually or through dry needling can provide marked pain relief. However, the points can  recur requiring further treatment. Muscles normally contract and relax as needed.  However if we do repetetive work in awkward positions and extremes of temperature  the muscles can get stuck in contraction  and  pain is one result.   Because muscle contraction ( which shortens the muscle length and increases pull on the attachment points at the joints)   people with arthritis suffer much more pain.   It is helpful to release the contracted muscles  which then reduces the pull on painful arthritic joints.  

      oooops   I did go on a bit.....

           

       

    • EileenH
      EileenH ricky23486

      Posted

      "oooops   I did go on a bit....."

      No you didn't - thank you for confirming what I have been saying for the last 6 years! And you have explained it so well.

      There are doctors who have confirmed my suspicion these things happen more often in PMR (not sure about other forms of arthritis) and there are PMR research people who aren't as aware of WHAT they are as they might be but who do realise that sorting them in other ways often helps the dose needed to manage the PMR.

      Wish you did live round the corner...

    • ricky23486
      ricky23486 EileenH

      Posted

       That makes me wonder whether anyone has considered doing a study to on the effect 
    • ricky23486
      ricky23486

      Posted

      clicked the wrong button... sorry...  I wonder if there is any data?
    • EileenH
      EileenH ricky23486

      Posted

      There is data somewhere (unfortunately not published I don't think) on the fact that the trigger spots in myofascial pain syndrome are the same cytokines as are assumed to cause PMR. They guy who did the work (an orthopaedic specialist in German) presented it at a science meeting in Innsbruck a few years ago. 

      Studies cost money - and it won't earn any pharmaceutical company any money so they don't care...

  • Anhaga
    Anhaga amkoffee

    Posted

    I've had arthritis in several parts of my spine for a long time.  Since starting pred journey I have spent a lot of time with a physiotherapist and one of the things she has done for me is relieve spasmed muscles in my back.  I had no idea I had them.  They obviously were contributing to severe hip pain, which I dubbed sciatica, as well as off and on chronic back pain.  With her therapies and my dutifully doing my exercises about 98% of the time I'm very much better.  I'd say the only effect pred ever had on the arthritic pain was to relieve it all at my highest dose, 15 mg.  I really enjoyed that month!  I'm getting some new pains now which have nothing to do with arthritis and could be a result of the long term pred affecting muscles, or the PMR process itself affecting blood vessels.  Sigh.

  • Loulie
    Loulie amkoffee

    Posted

    Hmm, I could have written your post myself!!  I wish I could tell you which condition is causing the pain but have no idea as I am just as confused about my pain too. What I can tell you is that I have been as high as 20mg of pred and it made not a blind bit of difference to the back pain so presumably this means it is not PMR caused. I have arthritis in the lower three lumbar vertebrae and also my facet joints. I went to an excellent chap in the pain management clinic last week as I had been referred by the orthopaedic surgeon for steroid injections into the facet joints and was told that as I am on pred it would make no difference additing to it by having injections into the facet joints. What he did say he could do was inject a tiny amount into the actual damaged nerve endings under X-ray which would last for a couple of days and if that brought relief he could then heat up the nerves to a high temp and presumably kill them off and then there would be relief for a couple of years (but not permanent).  All sounds a bit extreme to me!! So not a lot of help I am afraid, except to say that the common thread in all the replies is arthritis and presumably as muscle strength and tone is damaged by pmr and prd, this exacerbates the arthritic problem. Sigh! What a bloomin' mess we all are!

    • amkoffee
      amkoffee Loulie

      Posted

      You are right about that. But I just can't stand the thought of going years in this condition. I can't even do my whole shower routine before my back starts to spasm and I have to step out.

    • EileenH
      EileenH Loulie

      Posted

      "and was told that as I am on pred it would make no difference additing to it by having injections into the facet joints"

      I'm not sure I would agree. I had local treatment with steroid injections when I had sacroiliacitis when I was already on quite high doses of pred. They worked where the oral pred hadn't done the job. And as I say - the pain was being exaccerbated by muscle problems. That the oral pred didn't touch - but injections did. It was also from the pain clinic. They were considering the procedure you mention but I didn't need it in the end.

    • Loulie
      Loulie EileenH

      Posted

      Interesting, thank you Eileen. I will be seeing him again after I have seen a 'special' physio with the group who will send a report as to his findings. I will ask if he can do the facet injections in preference to the nerve endings. At least it is worth a try. 

Back to top

Report or request deletion

Thanks for your help!

We want the community to be a useful resource for our users but it is important to remember that the community are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the community is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.