Is four days long enough for pain to ease?
Posted , 9 users are following.
Taking 15mg of steroids but pain not reduced. Cannot climb stairs and only relief is when asleep. How long before medication starts to work or should Zi go back to Dr?
1 like, 11 replies
snapperblue susan32518
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PMR is considered treatable and you should not have to live with constant pain and inflammation. Good luck!
vawils susan32518
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MrsO-UK_Surrey susan32518
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3party susan32518
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Having learned all of that after it was clear that my local internists didn't have a clue, I decided -- arrogantly, no doubt -- that there was no point in seeing a specialist, i.e. a rheumatologist. What could s/he tell me that I did not already know? After six month of suffering, I surrendered and at only ten wekks' notice here in the wonderful land of private medicine (the US), I got an appointment, and saw said specialist last week. Did he tell me anything I did not already know?
Only this. He agreed with the diagnosis of PMR, and reiterated that prednisonenis the only drug that helps, but he strongly disagrees with the conventional wisdom (CW) about how it should be prescribed. CW is: Start as high as you need to, but no higher, typically 25-30 mg and reduce that pretty sharply after one week, holding at 15 mg for eight or ten weeks, then starting to taper. If pain returns, go back to 15mg and try tapering some weeks later. If pain does not return taper to 5mg, stay there for a couple of weeks, then 4, 3, 2, 1, 0, each for two or three weeks, and say goodbye to PMR for keeps.
This man's disagreement is about doses. He says the damage caused by LT use of cortisone is being played down, and that all the doses mentioned are too high. He would start at 10mg and go higher only if needed, and his objective would not be to get you off it altogether -- he says it does come back, frequently -- but to get the patient down to 5mg, and then a 2mg maintenance dose for ever and ever and ever.
I was very impressed by him, and he specializes in joint pain. But the only thing I learned is that his view about the appropriate doses differs from the majority view. As he says, the long-term effects of any steroids are well known. I hope this is of some interest, or even help.
twigjean 3party
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3party twigjean
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"Terrible" is about right. It is a national disgrace that you need money to get medical care in a wealthy country, but it is an industry in the US; elsewhere, it is still a profession.
twigjean 3party
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EileenH twigjean
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3party - I think he is wrong when he says that the longterm risks of pred are played down. That is the main problem we meet, doctors who are terrified of using pred properly and because of their fear and precipitate reductions they end up subjecting their patients to more pred overall and far more pain and distress.
The use of 15mg as a starting dose actually does what he says he does - there aren't that many patients who respond to 10mg quickly, mostly I suspect because they have been undiagnosed for so long there is a lot of inflammation to deal with. The paper from the Bristol rheumatologists I keep quoting starts at 15mg and in 3 months they have the patient down to 10mg where they keep them for a year. During that time there are few flares - flares are more often caused by too fast reductions than anything else. Reducing, flaring, going back up, reducing, flaring probably doesn't use less pred overall than using the very slow reduction we bang on about on these forums. And as has been said for years, the yoyo form of reduction arguably makes future reductions more difficult - at least judging by the patients I come across.
But if what you present as conventional wisdom is what is happening in the US (and frankly, I recognise it!!!) no wonder patients have problems! PMR will go away in its own good time, not before, You cannot relentlessly reduce and tell the patient the PMR has gone so you don't need pred. I have, over the last 2 1/2 years, pretty much done what he is saying except I started at 15mg but reduced slowly from the start. I have got to below 5mg, 3mg was a bit too far - and if I have to stay at 4mg for years I don't mind. Lower would be nicer I admit.
When I first was offered pred as a 6 week taper (15/10/5), I was great at 10mg - I do believe I would have got closer to 5mg then but the rheumy didn't think it was PMR so I was told I had to stop and it all came back. Since then it has been difficult to get that low without flares. Now I use the dead slow approach - no flares, no pain, no stiffness.
barbara75814 3party
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EileenH barbara75814
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EileenH susan32518
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https://patient.info/forums/discuss/pmr-gca-and-other-website-addresses-35316
Follow this link to a post with a load of other links - the second last one is the Bristol group paper aimed at GPs describing how they approach the diagnosis and management of PMR. It expalins how PMR should respond to a moderate dose of pred - and how other things don't. Take it to your GP and ask him to consider it.