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

Why pain reduces

Posted , 9 users are following.

margot34956
margot34956

Does anyone know why PMR pain decreases during the day?

It was also before pred that the pain decreased during the day.

Any help appreciated.

0 likes, 18 replies

18 Replies

  • nick67069
    nick67069 margot34956

    Posted

    PMR is form of Vasculitis ; cytokines cause inflammation in small blood vessels and thus restrict blood flow. My guess is that after we get up, we move around and that brings fresh blood to our starved muscles and reduces pain.
  • stevep63
    stevep63 margot34956

    Posted

    If your pain decreased during the day before pred, I would suggest you may have symptoms of something else such as RA rather than PMR? It may pay you to approach your doctor or specialist again. My stiffness with PMR worsens during the day unless I take pred.
    • EileenH
      EileenH stevep63

      Posted

      It really is yet another "everyone is different" - I know quite a few people who find that not too severe PMR improves through the day as mine did in the aquafit class. And alpine skiing also helped - especially my hips!!!! 

    • margot34956
      margot34956 stevep63

      Posted

      That's really interesting Steve, I will look up RA. Also approach Doctor. Thank you

  • EileenH
    EileenH margot34956

    Posted

    Once you start to get moving and the blood flow improves to the muscles then some of the pain fades, especially if you manage some gentle stretching in a warm shower for example. But it doesn't happen for everyone. I had 5 years of PMR without pred and every morning Mon-Fri I did an aquafit class in a warm pool. The earlier I did it, the better day I had. Especially when I had time to spend in the sauna or steam room. So I assume that it is vasodilation - the blood vessels becoming wider and allowing better blood flow to the muscles.

    • margot34956
      margot34956 EileenH

      Posted

      That certainly seems to be the answer. Thank you Eileen

      why did you not take pred for 5 years if you don't mind explaining?

      It is with movement, that the pain decreases, if I stop moving for a while, pain and stiffness is back.

    • EileenH
      EileenH margot34956

      Posted

      Because it was beyond the wit of my GP to work out that even if my blood markers were "in normal range" there was something other than "depression", "your age", "somatism" going on. Had I been sensible and worked my way around the GPs in the practice I might have found one who recognised what it was and done something. Even the rheumy I eventually saw didn't think it was PMR - despite a miracle in under 6 hours with 15mg of pred!

      The return of pain and stiffness if you are still for a short time is called myogelosis and is a typical finding in PMR. The doctors seem less aware of it though - they become fixated on "morning stiffness" which is often there but not always and patients often say "all day" which fools the doctors...

    • margot34956
      margot34956 EileenH

      Posted

      Sounds like you've not had much help from your GP or rheumy, it's so hard to know, when you trust the medical professionals . I no longer trust them. Thanks to you we are being informed.

      Bless you!

  • connie28112
    connie28112 margot34956

    Posted

    From what I understand, pain & inflammation levels follow the body’s levels of cortisol, which is a hormone & natural anti inflammatory. Cortisol levels dip overnight to become their lowest in the early morning. Body inflammation is highest then. Cortisol levels increase throughout the day, into the evening. 

    • margot34956
      margot34956 connie28112

      Posted

      Oh that's interesting, I wonder if there is any way to take or bring cortisol levels up, that might be worth investigating.

      Thank you for your reply

    • EileenH
      EileenH margot34956

      Posted

      It has been said by experts that. although a small number of people do have poorer adrenal function before developing PMR, it doesn't play a role in PMR itself. It is the malfunction of the immune system that causes the pro-inflammatory substances to attack the body. The cytokine IL-6 which is the one that causes the trouble in PMR/GCA is always present in the body and plays an important role in several processes - inflammation is an essential part of healing damaged tissue. But something goes wrong - and the cortisol doesn't play any role in that as far as they can tell.

    • margot34956
      margot34956 EileenH

      Posted

      Oh, very interesting Eileen, your knowledge is incredible. Thank you for all your help!
  • Anhaga
    Anhaga margot34956

    Posted

    One of the classic symptoms doctors still use to diagnose PMR is stiffness, usually worse in the morning..  Although many of us, myself included, dispute that is a useful description for us as, before treatment, pain and stiffness would return rapidly after even a short period of rest throughout the day.  So as Eileen says, we are all different.  When you are on pred of course any morning symptoms become relieved as pred does its fine work!
    • margot34956
      margot34956 Anhaga

      Posted

      Yes my Doctor did diagnose PMR because of the pain and stiffness being much worse in the mornings, along with the CRP test and response to pred. Yes the pain does come back after a rest. my job has me moving all day.

      Thanks for your reply. I hope you are doing better

    • Anhaga
      Anhaga margot34956

      Posted

      Thank you.  Pred has pretty much eliminated all my PMR symptoms, including what is called the "gel" phenomenon - when the muscles stiffen up with even a short period of inactivity.  I think if one experiences that while on pred the dose is not quite high enough.  There are other causes of stiffness, of course, and I have one of them, osteoarthritis.  

    • Anhaga
      Anhaga

      Posted

      should add, after "the dose is not quite high enough" : "or after a taper there is a bit of pred withdrawal which should go away in a few days".

    • margot34956
      margot34956 Anhaga

      Posted

      Great that is really helpful to know, some days are worse and I was wondering if it is the pred withdrawal or a reaction to exercise or even eating the wrong thing or maybe stress. So good to know if it is after a taper then goes back to normal pain it must be pred withdrawal. Thank you

       

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.