Pred masking other pain

I need some advice please........does pred. mask pain other than from PMR? I am continually confused at what is PMR pain and what is pain from the one fractured femur and the other pinned femur but not healed thanks to the pred. I think I have had a flare due to lots of pressure at work and I also know that I am walking very badly favouring the leg with the fracture and this is throwing my spine (spondilyliosthesis) out and the back of my pelvis. Crutches when out don't help the shoulder and add intense hand pain although an indoor wheelie does help me to walk a little taller. I need to make a decision before the end of year whether to have the fractured leg pinned ( am always at risk of it snapping if I slip) but I have been told that it could snap during surgery leaving me with a second pinned leg not healing. I am using ultrasound bone healing machines (Exogen) which are certainly helping new bone growth in the pinned leg but the fractured leg has become more painful lately. I am not sure if this is muscle pain from the PMR or pain from the femur which is what I need to get a handle on. The problem is that these femurs are bang next to one of the largest muscles in the body in the thigh...a perfect target for PMR. Any help gladly received. Ida

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  • #ida-June128

    I wish I had an answer for you as you are going through so much. I think you need to have a doctor sort out this problem. I would think the Prednisone would mask any pain but if you are on a really low dose perhaps not a femur break. I hope others can offer you help.

  • Like Ronswife I think that a doctor is the only person who can answer your question properly. Certainly, being an anti imflamatory the pred will mask pain, as it did with my arthritic knees when my dose was above 20 mg. Now down to 14 and I am having to take other pain killers again. What a lot you are going through, my thoughts are with you and I hope you find a resolution soon. Take care.

  • Yes it can - many people getting to the lower doses find they are having pain that is most probably osteoarthritis which the pred was masking to some extent. It is the reason many rheumies ask patients about whose diagnosis they aren't sure to stop their pred to see what is going on. Obviously, patients who have had pain relief with pred are not amused when pain returns but it may well not have been PMR as we discuss it here and may respond better to another approach - and when all is said and done, there is no cure for PMR, there may be for other problems. PMR is just the symptoms of some underlying problem and that can be quite varied in origin. Thigh muscle pain is not restricted to PMR - bursitis, piriformis syndrome, myofascial pain syndrome leading to sciatica and other reasons for sciatica can all mimic the PMR discomfort/pain.

    If you already have spondyliliothesis and are walking badly because of the fractures then you are a prime candidate for back muscle problems which, when spasmed, can cause a lot of pain down into the thighs whether myofascial pain syndrome effects or piriformis syndrome - I know, been there! I found that the pain down the outside of my thigh into the knee, even into the calves and ankles at times, was either sciatica or referred pain due to low back problems that trapped/irritated the sciatic nerve. Now they are pretty much sorted that pain is gone.

    This is probably going to sound rather harsh - but how bad was your putative PMR? I had PMR for 5 years without pred and, while under current circumstances I say I would not wish to go back there, it wasn't the end of the world and I was as at least as mobile as you are now. Faced with the problem of non-healing of bone due to pred as you are, I THINK I would consider stopping the pred to see if the bones healed. I can only say I think because I truly don't know, I'm not faced with it.

    But as Ronswife says - it is something you have to discuss with your surgeons. Would THEY prefer you stopped the pred so they can operate with a bit more certainty?

  • Thanks PMR Pro, I have a horrid feeling that I will have to consent to surgery to pin the fractured femur. It has got considerably worse this last week since an altercation with some 10' high sliding doors that jammed and I don't think I can go on like this for much longer. I can cope for a couple of hours after the Tramadol + Parecetamol but coming up for the next dose (5 hourly) I am in trouble. I have been swerving the surgery for not only the possible break during surgery reason but that it will stop me driving being the right leg although I have got all the details to have my geriatric Merc. converted to hand controls for a while. When the PMR started just over four years ago within 3 days I could not dress myself or lift a toothbrush to my mouth and a friend helped shower me and wash my hair. I was using a tens machine 24/7. My GP first diagnosed a Vit D deficiency - there was none in my system at all - but when I finally balgged a private doctor to prescribe me 15 mg pred a day within 36 hours the relief was amazing. This was 4 months after the start of the pain. I then went back to my GP who finally referred me to a rheumy, th ESR was 61 I seem to remember and the rest is history. When they pinned the first femur almost 3 years ago they actually upped the steroids to 40mg a day whilst in hospital. From my view I would not consider stopping the pred at this time.

  • Fair enough - and a high ESR was very likely showing there was something beyond the vit D deficiency causing the problem.

    The increased pred dose while in surgery will have been to reduce the risk of adrenal crisis but I'm surprised they went so high. YOu obviously had a really bad onset of PMR - mine crept up and while getting dressed was INTERESTING to say the least I could just manage. Teeth and hair was another matter - thank goodness for electric toothbrushes!!!!!!

  • I was just wondering if ultrasound bone stimulation can be applied in any way to counter the basic bone loss typical with PMR.

  • There is no basic bone mass loss that is typical of PMR. The loss of bone density associated with PMR is more likely to be due to the pred used in management. PPIs are also associated with loss of bone density.

    However, by no means all patients on pred lose bone density - only about 40% of patients treated with pred have problems and 55% of the general population in the USA have reduced bone density. Generally there is no way of knowing whether patients were already osteopeneic/osteoporitic before diagnosis unless the dexascan is done immediately as the greatest bone density loss is felt to happen in the first 3 months of therapy with pred.

    I had been on pred for about 4 years and there was no change in bone density, I had only taken calcium and vit D supplements. There are several patients I know of on the forums with similar stories - some even didn't take calcium/vit D.

    If I remember rightly, Ida-June's problem is not so much loss of bone density as the development of spontaneous femoral fractures - which are a hallmark of treatment with alendronic acid, a bisphosphonate claimed to increase bone density and so avoid femoral fractures!

  • Thanks for the info. The reason I asked is that my Rheumy wants me to take alendronic acid due to a borderline bone density problem. After reading about the stuff I begged off, but I've been thinking about substitutes. He's also mentioned Prolia. Is that a bisphosphonate or something else? I'm supposed to have another bone scan in November, so I'm starting to think about this again.

  • If you are only borderline they shouldn't even be offering you the drugs. The first line of defence includes nutrition and exercise. Have you been given any guidance regarding that? It goes way beyond the basics of Calcium and D3. I'm taking the liberty of private messaging you my little osteoporosis journey essay, which includes a short bibliography.

  • If you are in the UK, go to the NOS website:

    nos.org.uk/

    They also have a helpline which is excellent and they will talk you through your options.

    You say "borderline" - what are your t-scores?

  • I'm in Montreal, Canada but the website looks interesting from here, too. I don't remember the number for my t-scores, but when I looked at the chart that I found on the Internet somewhere, for my age the femoral neck score put me in the high moderate risk for a fracture at some point. The lumbar score was good. GP and rheumy both said that was because of calcification from arthritis that lowered the readings in the lumbar area. To me, the basic logic says to scan some other bones to resolve the contradiction, but no one has picked up on that. I just don't feel that I have a real problem with bones, and I don't want to take one medication to counter the effects of the first medication if not absolutely necessary. If you start down that path, where does it end?

  • You need to discuss the dexascan with an expert (and that doesn't mean a GP or rheumy!) - I'm sure there must be an equivalent to NOS in Canada.

    The dexascan works on evaluating the density in the NOF and the spine. It is the NOF that is the concern - a fractured hip in elderly patients can be enough to limit them living independently at best and life threatening at worst That is the basis of the desire to use bone-strengthening medications. With a big enough buffer there are other ways of increasing bone density - although to be fair, people with low bone density don't have fractures, people with normal bone density do so there is a lot to argue about.

    I'm sure Anhaga has sent you interesting info - but there is a point at which the readings take you into the osteoporosis realm and you have to consider your approach carefully. There are a lot of ways of reducing the risk of a hip fracture which have nothing to do with bone density - sort out any factor that might increase the risk of falls for a start: remove trailing cables, rugs and pets from your environment. Good lighting, especially on stairs and around door steps is essential, even for young people. There are hip protectors to wear - although they are more aimed at the elderly. I have no idea how old you are...

  • I'm 70 and do need to turn on a night light around the house. The wife and kids won't let me get rid of the cat, though, even if I wanted to. I'll just have to walk with slow, shuffling steps more and more as the years pass. I'm sorry, I don't know what NOS stands for. Is that a medical consultation service in the UK? To my knowledge, there is nothing like that in Quebec.

  • National Osteoporosis Society - I assumed if you'd looked at the site you'd have noticed, sorry.

    Here's a link for the Canadian one - they have a toll-free number and local chapters:

    osteoporosis.ca/

    Then you have to be extra careful if the cat is around your feet - lots of people fall over pets winding around their ankles. It isn't just at night though - it is in the daytime too and just a nightlight is often not enough - proper lightbulbs too, not these eco ones that take forever to get to brightness!

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