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PMR & mid back pain

Hi all, I've had PMR for just on 2 years now. Have been reducing my pred very slowly over this time and down to just 1mg daily. Neck, upper arms and upper leg pain almost gone most of the time but have had mid back pain (both sides of spine) on waking for a couple of months now. It's very painful first thing but will improve through the day (as was the case when I had pain in the other areas). It definitely feels like the muscles being affected. Ideas anyone?

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Myofascial pain syndrome is often found alongside PMR, it is caused by the same inflammatory substances as PMR but they tend to be concentrated in so-called trigger points which form in pairs alongside the spine, in the shoulder muscles, about rib level and in the lower back. These trigger points can be felt as hard knots of spasmed muscle fibres in the larger muscles and can irritate nearby nerves giving rise to referred pain in the areas the nerves supply. The can also make the rest of the muscle sore and lead to it being hard and tight, going into spasm over a larger area.

The trigger points can be dispersed in several ways: using local steroid injections, using techniques various called needling, intramuscular stimulation and prolotherapy (all use needles similar to acupuncture but they are different) or by manual mobilisation techniques where finger and thumbs (and even elbows!) are used to work on the hard areas of fibres. As well as these techniques (I've had them all!) I and others have also found Bowen therapy very useful when it isn't in too bad a state.

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Thankyou very much for your prompt reply. Who would be the best person to identify where these trigger points/ hard knots? A Physiotherapist? By the way, I find swimming causes no pain in this area and often relieves it completely.


I had used Bowen therapy in the early days of my PMR (no pred, not from choice!) and was fairly sure that MPS was that caused these particular problems but it was finally officially named by the local pain specialist when my back had a complete meltdown and I couldn't move! She is an anaesthetist but identified the problem points in minutes. The hospital physio also had no problem finding it. I had previously been told by an orthopaedic specialist I saw because of whiplash due to a car accident that the low back pain was wear and tear and there was nothing that could be done, I'd have to live with it! Sorting the muscle problems sorted the pain! So I don't recommend a doctor! Previously I had also had excellent treatment from a sport physiotherapist. I should say that none of this was done in the UK and I had had poor experiences with NHS physios - only two out of several were prepared to work on it. Personally I would look for a sports physio or sports massage therapist - or would google the techniques I mentioned above to see if there is a therapist offering them in your area.

Are you in the UK? If so what region?


Yes im in hertfotdshire


I know intramuscular stimulation has a lot of practitioners south of about Leicester. I haven't tried that under that name but a friend was referred from Addenbrookes to a practice near Newmarket I think and she also thinks it is a superb technique for back muscle problems. It's the sort of therapy I would expect to find in physio practices where they deal with sportspeople.


Thanks very much for your help. From what I've read myofascial pain is generally in asymmetric areas and mine occurs in both muscles either side of spine. I have a good physio practice in my area so will see what they think.


I have it both sides! From top to bottom! Especially the discomfort that spreads into both shoulder blades and both sacroiliac joints though there one starts earlier than the other.

The trigger points often develop in pairs - if they develop in pairs, they can affect both sides. Of course, it may not be MPS - but a sports physio is a good place to start for muscle problems.

Good luck



Last week my PCP tried needling four knots in my neck and upper back area with a local anesthetic. It helped that day, the knots are better, but the severe burning pain continues. I have had this pain for weeks. I have tried heat/ice which gives a little temporary relief. When I do much walking or physical work, the pain is so severe, it almost brings me to the ground.

Any suggestions. Thanks for all your insights.


I found it took several sessions to get a good result, it won't disappear with just one session - do ask your PCP about it. If there was nerve irritation/inflammation it may take a while to fade. And frankly - avoiding the activities that make it worse is also needed. There are things I know I can't do - however much I would like to.


My mid back pain was what prompted my gp to put me on steroids and see a physio. Happy cat angry cat exercises. Once steroids had kicked in I was discharged from physio but told to continue with exercises and posture stuff. Am worried about mid back pain returning but will face that obstacle if and when.


Hi. I visited my physio yesterday who couldnt find anything obvious. As its on both sides i think its the pmr but in a different area to the norm

I had it in both forearms before after working in the gardem so perhaps overuse of any muscle group will agitate it


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