Increase Pred or take Paracetamol or Ibuprofen?

Posted , 13 users are following.

Hi All, I've had great encouragement from this forum over the last year so thanks to everyone for the support and shared experiences.

I've dropped to 6mg (originally at 15mg almost 18 months ago when diagnosed aged 55).  Using DSNS from 15 to 10mg was straight forward and I felt I was doing great and feeling lucky.  It's since become more challenging, particularly from 7mg to 6mg - in retrospect I should have dropped by half than a full 1mg!  Back to feeling really stiff for longer periods; through the night, waking up when I need to move in bed, and when getting up in the morning,  I find getting out and walking helps but am frustrated with the stiffness.  My question is; is it ok to take a couple of ibuprofen and/or paracetamol for some relief or should I increase pred to 7mg?  I guess I'm reluctant to increase, having just lost the hamster face!!  I've stuck it out for c4 weeks but things aren't improving and have just tried paracetamol over the last few days, intermittently (one day on two days off etc) and it seems to help the days I take it, although it would be good to feel better and quicker/earlier in the day smile

Anyone been at a similar stage - what worked?

0 likes, 21 replies

21 Replies

  • Posted

    Taking ibuprofen or any other NSAID can cause stomach upset. Combine that with prednisone which can also cause stomach upset and you're asking for some real GI problems. Also it does not work for PMR pain. For whatever reason PMR pain really only response to an anti-inflammatory like prednisone. When I was diagnosed with PMR ( I was 55 also) I was already taking narcotics for lower back pain and yet I still felt all the pain from PMR. If you really don't want to increase your prednisone dosage you might consider trying turmeric and other known anti-inflammatory supplements. If you're not already taking any it would be worth trying it. I tried turmeric myself but it upset my stomach too much.

    • Posted

      Hi Amkoffee, Thanks for your advise.  I do take Omeprazole for stomach and I've heard about Turmeric so will certainly give it a try.  Good luck with your journey, keep well. J

       

  • Posted

    Hi Jan. I am about your level 6mg after 18months. I am taking half a teaspoon of bicarb of soda or baking powder, in  small glass of water before I go to bed, its supposed to be an antinflammtory  I do feel a lot better after  2 weeks, sometimes I miss a night smile  give it a try cannot do any harm, I hope. good luck

     

     

    • Posted

      Hi Patricia - I have read somewhere about bicarb and baking powder, doesn't it matter which one you take?  Definitely worth trying - I'll give it a go tonight.  Thank you. smile

  • Posted

    As amkoffee says Ibuprofen is contra indicative with Pred and does not work anyway to relieve PMR pain. You can take paracetamol though this also does not help PMR pain but it will help other pain you may have.
  • Posted

    Jan, if your pain is PMR NSAIDs will not help. You need more Prednisone to stabilize your inflammation and get it under control. PMR is always there and you need the amount of Prednisone control the inflammation if not the inflammation will get in control and you will need more Prednisone to get it control. I was at 7mg out of control flare and had to go to 30 mg to get relief. Good luck on the rest of your journey. Try to stay positive and smile. ☺️

    • Posted

      HI Michdonn, thanks for your advice - Sorry you had to go up so high, I certainly don't want to have to go way up so might just have to go back to 7mg and hopefully get better relief.  Thanks for sharing your experience.  Good luck smile

       

    • Posted

      You are welcome Jan, that is what good about the forum, sharing knowledge and experience. Good luck the rest of your journey. Think positive and try to smile. ☺️
  • Posted

    I think there needs to be a more nuanced discussion about NSAIDs.  Contrary to what is often written in this forum, they are anti-inflammatory (it is in the name) and this will have some effect on the pains of PMR.  However, it is not as effective as Pred and as a substitute would have to be taken in such large doses over a long period of time that the potential side effects would become almost inevitable – acute gastric crisis and increased cardiac risks.

    There is a discussion to be had about whether NSAIDs could be used occasionally as a supplement to Pred during tapering.  As the NHS says on its official PMR website:  “Your doctor may prescribe other painkillers, such as paracetomol or NSAIDs, to help relieve your pain and stiffness while your dose of prednisolone is reduced”.   I have occasionally used NSAIDs in this way, and it did eliminate residual PMR pains and relapsing symptoms for the days it was taken.  I have never taken NSAIDs as a long term measure for PMR, even as supplement.  

    Prednisolone is also aggravating to the stomach and adding NSAIDs to the mix will make this effect much worse.  Doing so – even occasionally – should only be considered if you are on a protective PPI as well (Omezaprole, Lanzaprole etc), which many of us are anyway.

     As so much with PMR, research into these matters is weak.  It would be nice to know more from clinical research and trials.

    • Posted

      I have to say I don't know where you have seen on this forum that people say NSAIDs are not anti -inflammatory - it's all  in the name Non-Steroidal Anti-Inflammatory Drugs. What we DO say, repeatedly and as the result of long experience, is that NSAIDs mostly do not deal with PMR pain while they may help steroid withdrawal pain which is so similar to PMR pain you can't tell the difference. 

      "research into these matters is weak" - what matters?

    • Posted

      Thanks Dmart, good advice, I will stay clear of the Iboprofen to be on the safe side. Many thanks.
    • Posted

      Just because something is anti inflammatory it does not mean that it helps the PMR pain. NSAIDs are pretty horrendous side effects wise so why not stick with pred?  I do agree if you have got something else they may work fine but pred for PMR. 
  • Posted

     At one stage when I was getting down to lower doses ( around 7 ) my GP asked me to try Paracetamol to see if it helped my pain and stiffness, his reasoning being that maybe the pain was down to my long term OA. and if the Paracetamol controlled it then we could probably assume that it was no longer PMR. 

    Like you, I found a marginal improvement stiffness wise. but the pain remained. I tried for a week but  had to stop because, unlike the rest of the world, it turns out I must not take Paracetamol which is another story. So back to just the Pred. and eventually ( five years ) I got to zero.

    It doesn't sound as though it's giving you much help and four weeks is giving it a good chance to see. Four weeks is also a long time to be in such discomfort.. If it were me I'd go back to the Pred. dose where I was last comfortable. 7 is quite a low dose and maybe not enough to give you hamster face. 

    • Posted

      Thanks Betty, it's great to hear some good news of people getting to zero.  Five years is nothing when you're feeling well. smile

       

  • Posted

    You are not reducing relentlessly to zero: you are looking for the lowest dose that manages the inflammation as well as the starting dose did. And at a guess you have found it: 7mg, possibly even 6.5mg. If you ignore this now you run the risk of letting it develop into a proper flare as the inflammation builds up again, like a dripping tap filling a bucket, and then you will have to go back to a considerably higher dose to get it under control

    It doesn;t matter how slowly you reduce - you will not get below that dose which is just enough to manage the daily dose of inflammation,

    • Posted

      And PS - an extra mg of pred has far fewer side effects than NSAIDs, especially taken in combo with pred, something that really isn't advised long term.

    • Posted

      Hi Eileen, It's great to get your positive wisdom on the matter.  You certainly make me feel better about 'no big deal in going back to 7mg'; keep of the NSAID's and avoid the major flair.  I certainly don't want to wait until that dripping tap fills my bucket to overflow mode!

      I'm going to try the bicarb/baking powder and get some great recipes with turmeric, if I still feel the same in a couple of days I'll move back to 7mg.

      Thank you so much everyone for your great support and advice - this forum is so much more helpful than our GP experiences.    smile

    • Posted

      Hi Eileen

      Wanted to get your opinion on the baking soda and water approach to reducing inflammation.  Been reading a few articles, some cautioning liver/kidney problems....

    • Posted

      The research is very early basic stuff, done in rats and just a few healthy humans. The paper repeatedly says "may", "possibly" and that it needs to be confirmed. One of the reports of the work interviewed the lead author and quoted him as saying "don't do this at home".

      https://drugsafetynews.com/2018/05/02/could-an-effective-treatment-for-autoimmune-disease-be-as-simple-as-drinking-baking-soda/

      OTOH, it has been a home remedy for indigestion for years. One risk of trying it may be that you lose potassium through the kidneys - and in this very hot weather that may add to dehydration problems.

    • Posted

      Thanks Eileen.  Have you been tempted to try this?
    • Posted

      No, not really. I read the nearest to the paper I could! And decided I wouldn't try it at home yet...

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