stiffness versus pain

I shoul add that in my case there is a possibility that I have PMR-induced inflammatory arthritis according to the "experts"....

You might be interested to read that a project on Stiffness in Polymyalgia has been carried out  on groups of patients in different parts of the UK., and putting all the results together provided some final findings:

Firstly, stiffness was related to three overarching themes of perceiving, thinking and doing.  

Secondly, stiffness was preceived as being different to pain or fatigue but with variable overlap.  Patients thought about stiffness in very diverse ways, the expectation of worsening in the morning also had a cognitive impact.  Stiffness prevented patients from carrying out activities, including fundamental activities of daily living.

Finally, numeric rating scales for stiffness were seen as problematic by many patients, but were more acceptable with anchoring words to define what was being measured or with comparisons between different times of day.  Assessment of severity by assessing function made more sense to patients.

The study suggested that a core outcome set for PMR should include the symptoms of pain/ache, stiffness/restriction of movement, and inability to perform everyday tasks.  These different symptoms may relate to each other in a complex way and this should be incorporated into study design and plans for analysis.

Hope you find that interesting and it helps to answer your questions.

over the next two months the pains simply got worse and worse. The pain was like sitting out in the sun, getting very, very sunburnt, then digging long sharp nails into the burnt skin and scratching the skin. That's the only way I can describe the pain but the intensely was way, way more than that. I then got shooting pains across my shoulders and down the tops of my arms, they resembled shooting nerve pains. By the time I saw the consultant I also had pain in both thumbs, the outside of my left wrist, my entire rib cage including a terrible pain to the left of my sternum just under my breast bone.

if I lay down or sat down and didn't move then I had no pain. I had no swelling and mostly if i touched myself I did not experience any pain. But if I moved at all, my god the pain was unbelievable. I couldn't sleep because I could not get comfortable in bed and of course I didn't want to move because of the pain.i could not get in or out of bed or a car without help, and if I drove the pain in my upper arms when I changed gears was unbelievable. I couldn't kneel or bend forward because of the pain. I couldn't turn my head from side to side because of the pain. If I went to the toilet the pain bending my knees and hips when rising up and down was unbelievable. I couldn't carry anything heavy as my upper arms pained do much, I couldn't climb up stairs and when I tried to get in the shower I couldn't left my left leg not 8 inches to get in the shower. My husband bought me a foot scrubber thingy so my feet could be gleaned because I couldn't lift my feet up. When my husband wasn't looking I cried and cried because I felt locked in a body that if moved was so painful.

but did I ecperience stiffness, well that's interesting because the pain was so bad that I simply couldn't contemplate moving and so stiffness set in and I suppose it could be argued that I appeared to be stiff because when I moved I moved with very little movement because greater movement resulted in greater pain which was something I could tolerate. So maybe looking back, I wasn't stiff it just appeared to an onlooker that I was stiff because I didn't want to move. However, saying that following being helped out if the car it did take me a few minutes to straighten up and start moving. So maybe I did experience stiffness

i've just looked back to your thread an you have used the word 'screaming' as a description of the pain and I think that is a very good description whilst I could never describe my pain as an ache. 

Throughout this time the pain was definately worse in the morning and throughout the day the pain did lesson especially my hips when I tried to keep walking hoping that the pain would go away.

i took my very first dose of 15mgs of prednisone and within four hours I was walking up the stairs, turning my head from side to side and the pain except for a few places was all but gone.

hope that helps you, noninoni, christina 

So with that background, here's my (possibly unconventional) summary of pain.

Stiffness was noticeable when climbing out of truck after driving (average 100km/day on rough roads). Also noticeable in legs after walking, as little as 2km. 10km on hills was major and exhausting. A day's sight-seeing had to become half a day. Then rest. At all times I couldn't take my normal stride. Shorter than normal. At the extreme was mild pain, localised at inside top of thighs, but it was the stiffness that limited movement. The longer the step the greater the effort. Like fighting an elastic band.

The pain in upper arms was always there. Right arm worse than left. Outside of upper arm. Press and it hurt.

Sharper, more intense, when I caught an arm in an unusual position. Either behind or above shoulder (when I could get them that far) or reaching for something. I learned not to reach for things - not hard, I'd had to change behaviour 25 years earlier with back problems and our truck is ergonomic.

Rolling over in the middle of the night I didn't have much control over. That's when most of the screams occurred. Sharp, localised, focused, intense, excruciating, pain. On top of the more diffuse background pain. The focus is "inside" my muscle. Worse or better as arm position changed. Get my arms to best position and use all the relaxation / pain management techniques I knew. My wife thought I was practicing for a birth. It could subside to a duller pain after several minutes, still with the same origin, but not as localised, a little more diffuse. But chronic pain that never went away.

Taking off or putting on a tee shirt was interesting. On a good day (before pred) I could just manage. Either my arms wouldn't move where they should do or the pain was too sharp.

"Stretching" for things involved an emergency disconnection of battery. Mind over matter. Sharp excruciating, pervasive, pain. So intense I could hardly concentrate. A wall between me and the battery. No alternative than to move my arms where they had to go. Use left arm to move right arm and hope it stays where I put it. Be methodical. Turn the spanner a little at a time. Quick before the truck goes up in flames ......... A bit melodramatic but it was screaming bright red sharp burning pervasive pain in upper arms like I have experienced only a few times in life. Everything all at once. And unavoidable.

Very different to the cramps I currently get in the middle of the night in my calf muscles. That's just annoying. Soccer players must be babies!

Just for fun I also have leftover numbness in one leg from back problem. That seems to be more sensitive currently. I mention it simply because its another variety of "pain". Very much surface, spread over a large area. Have to touch it to notice it. I'm hoping the pred is not masking the return of back problems. Nerve pain (of squashed nerves) is different again.

Driving was easier than being passenger. I had the steering wheel to hang on to. Turning the wheel caused the arm pain to sharpen. Basically movement was painful. Changing gear was a challenge. Grin and bear it, drive to avoid gear changes.

At times it felt that my leg was weaker than normal. The clutch is quite heavy.

My hands were visibly swollen and stiff. More recently (three months after start of pred) there's no visible swelling but the first part of my fingers attached to hand are both stiff and painful. A rather nice pain (if that's possible). A background pain, along the length of the bit between the joints, that intensifies when I do anything with my hands. But not debilitating. Not limiting. The sort of stiffness/pain experienced after a lot of exercise. Not something that stops me using my hands.

For me diffuse stiffness, ache, sharp pain, are just descriptors on a spectrum. I don't categorise things well. For some reason I mildly think in terms of brown through orange to describe my PMR pain. But that's not much use to most others I talk to.

Basically I find our language is not very good for describing "pain".

Perhaps another aspect is the sense of PMR as a wave washing through me. What started as a mild irritation in one arm and a shortness of stride seems to have slowly washed through me. I have a sense that my right arm is no longer "worst". That my left arm has become worse then improved. That my upper legs are more stiff. That whatever it is has washed into my lower legs, feet, and of course hands. Either wishful thinking or reality. I'll know some day in the future.

For some reason I think a little pain is useful. It gives me a sense of where I'm up to. I can tell better or worse. I can pace what I do. A flare is not something or nothing, for me its worse then better. But never gone.

In early life I learned that pain is a warning. Change what I'm doing before I do some more damage. Later I learned that there can be pain without doing damage.

One aspect of PMR which I haven't quite understood yet is whether the pain is associated with damage being caused or an outcome of the inflammation. I'm guessing its simply an outcome. A symptom. Not a reason to not move.

When finally diagnosed the effect of the pred was noticeable within hours. From having to think about and struggle with every little movement to mindlessly running up stairs three at a time - how good was that?

I probably wrote the above just to confuse and confound the statisticians and those who want to put things in little boxes. And writing it down helps clarify for myself what I'm dealing with.

I'm 65, reasonably fit, active but lazy, and btw noni, a meagre male.