PMR flare ??
Posted , 7 users are following.
Hi Forum friends,
Some eight months ago, I posted a message about my query over my leg pain being a new Sciatica pain or PMR flare. Just to recap, I was diagnosed with PMR 4 1/2 years ago. I had about 3 flares during that time, each episode was related to my incorrect reduction and lack of understanding of the PMR process. Presently I am still suffering from sciatica left leg pain, which makes sitting painful and uncomfortable. Sometime the leg pain is so similar to PMR pain which made me very confused whether I am having Sciatica pain or PMR pain. I am on 7.5mg having reduced it from 10mg with the DSNS method since November. I have all along what i regard as 'bearable pain' that I could live with. But recently, about a week ago, after a long haul flight back from holiday, I have severe pain on my shoulder (across my shoulder) and on one side my upper arm. I have not had pain on my upper arm before, so I am not sure whether this is related to PMR .
I thought it might have been due to my carrying a small back pack, but after resting for a few nights, the pain is still there. Despite taking Naproxen or Co-codymaol, i still got this pain across my shoulder !! I dont have pain on my pelvic area, the left leg pain could still be my Sciatica pain.
My question is,is this a flare up of my PMR ? should I increase my Pred? and by how much. thank you for your advice.
0 likes, 6 replies
EileenH ling42044
Posted
You could have back muscle problems - they cause me a lot of that sort of pain. Especially piriformis syndrome for low back or myofascial pain syndrome (MPS) for all areas. In MPS trigger points form in muscle groups on either side of the spine, in the shoulders, about rib level and low back about where the baby's dimples are. The trigger points are concentrations of the same inflammatory substances that cause PMR when they are systemic (all through the body in the blood supply) but here they cause hard and inflamed muscle fibres and also inflame the muscle fascia (the thin transparent skin you will know from joints of meat or poultry). These hard muscles can irritate nearby nerves - causing referred pain in the shoulders and neck, in the ribs and the low back and legs (sciatic).
And a long flight is the perfect way to prod those just-about-managing back muscles into meltdown!!!! Even lifting something too heavy or - as has happened to me at times - you catching your head on the car door as you get in or out will do it!
Anyway - there is no reason why you shouldn't try a few days of a much higher dose than you are currently using to see if it helps - in which case if it works quickly it is most likely to be PMR, if it is slow/doesn't work then probably not. You can add 5mg a day for up to a week and then drop straight back to the old dose if it doesn't help - no slow taper required.
I have just had a week of high dose NSAID infusions to sort my low back pain - after 10 days of excruciating stabbing when trying to get from seated to standing. That sorted that - but then the trochanteric bursitis came along to play so that required steroid shots! Seems OK now - I hope!!!!!
EileenH
Posted
PS - forgot to say - a good sports/therapeutic massage works well for me when caught in time. Or I used to use Bowen therapy pretty successfully in the UK - what I get here isn't available there.
ling42044 EileenH
Posted
Hi Eileen
Thank you so much for your timely reply, just what i've been waiting for. For my ?? sciatica pain which i am seeing an NHS physio, and they just advised me on stretching exercises which i have been doing all along !! I still think that I got trapped nerve somewhere. I had spine x-ray which showed some degenerative changes on L4 & L5 appropriate to ageing process, but it will be hard push to get them to refer me for a MRI !
My shoulder pain is not decreasing, it is getting me down, and I cant do much, even reading with my head down is uncomfortable ! Having read previous comments on this forum site, i have decided to go up my Pred
to 12.5mg (from 7.5mg) just as you suggested. I wasn't sure how long to go up for , I hope this is about the right increase and i will do it for a week and see.
Since my PMR diagnosis, i have kept a diary of symptoms, and i've found out that i have similar shoulder pain before in the first 2 years, that is what made me suspect that this might be a flare. But how did that happen suddenly when i was fairly stable decreasing my Pred on DS method ? I wonder whether the long haul flight had something to do with this? Along side this, I am still suffering from unilateral leg pain from presumably Sciatica.
Thank you for listening, and advice. Such a wonderful forum. It is better than my GP and Rheumatologist .
EileenH ling42044
Posted
Honestly - hauling a case around, however big or small, and sitting still for ages on a plane doesn't help back/shoulder pain at all! Which is why I request airport assistance! They will grab the case for you...
ling42044 EileenH
Posted
HI Eileen
With reference to the above query, I would like to ask whether my increase of 12.5mg of Pred from 7.5mg is sufficient to deal with the flare of my shoulder ache. I've had the increase dose of 12.5mg for 3 days now, it's a "little" bit easier, but not by any means gone! Do you think I should go up a bit more to curb the inflammation, and then come down again when I dont have any more pain.
Thank you for your advice.
EileenH ling42044
Posted
It's impossible to say whether the pain is due to a flare of PMR (which I would doubt to be honest) or more simply you asked your muscles to do things they didn't want to/couldn't. Your muscles are intolerant of acute exercise - they feel abused. Because of PMR, instead of recovering in a few days as delayed onset muscle soreness normally does, it will take longer. If the muscles are injured, however minor, then pred won't help. Painkillers might - but be careful taking NSAIDs with pred for more than a few doses.
You could have developed the shoulder pain by wrenching your shoulder picking your case up off the carousel - that is made even more likely because you are on pred, it doesn't do muscles or tendons a lot of good, you have to exercise care too.