15 mg or 10??

[Navion]

Hi all,

I have been on prednisone for 1 month. I suspect I've had PMR for 15 months, but was just diagnosed 3 months ago. The first week I was at only 5 mg which made me feel significantly better. However, I still had quite a bit of burning pain between my shoulder blades and a really stiff neck . The last 3 weeks have been at 10, which cut the pain in my back a bit and pretty much alleviated the pain and stiffness in my hips, legs, knee, shoulders, and collarbone.. I think my rheumatologist started me off slow because I refused the prednisone for two months and I almost always react badly to medication and she didn't want to freak me out.

I just had another appointment on Thursday. She suggested that I could increase to 15 mg for 3 days to see if it helped the pain in my back and rib area substantially or the neck stiffness. She said if it didn't help the pain much or if I got worse side effects that I should drop back down to 10 mg after 3 days and stay there for another month.. I hate to keep chasing the pain between my shoulder blades by increasing dosage when I feel pretty good except for that area. I also suspect the remaining pain may be due to a disc issue in my neck, and not PMR. However, the pain seems a little better today, my 2nd day on 15 mg. Do you see any problem with going the 3 days and then dropping back if I see only slight improvement? Thanks.

[Yellowbluebell]

Hi, welcome to the site. Usually if you only spend a few days at a higher dose it is ok to drop to your previous dose. If you have had an improvement with the shoulder pain on the higher dose then it does suggest 15mg is what you need. Hopefully staying on 15mg for the 3 days will give you the relief you need and you can stay on that dose and speak to your rheumy about tapering once everything is under control. If there is not much improvement then you can just go back to 10mg. You will hear from other forum members when they wake up as most of the UK is in bed now. Keep us up to date on how you are getting on.

[PMRpro Ambassador]

None whatsoever - except that dropping by 33% is really not recommended at any stage! You are supposed to be tapering (as opposed to reducing) to find the lowest dose that gives the same result as the starting dose did. It also takes a while for the established existing inflammation to be cleared out and maybe a month of 15mg wasn't long enough. However - it is recommended that in tapering each step down is not more than 10% of the current dose. Makes it more comfortable all ways round really.

My back pain is not due to disc problems - it is myofascial pain syndrome that is a part of my version of PMR, something that is actually quite common. The muscles spasm and pinch the nerves - just like a disc can. It improves for me at higher pred doses.

[Navion in reply to PMRpro]

I am currently on 10 and was supposed to try 15 for just three days to see if it helps. My doctor said that after 3 days I could just drop back down if the 15 seemed the same as 10 with regard to pain.

[PMRpro Ambassador in reply to Navion]

That's fair enough - but just a suggestion that maybe it is something that can be approached with non-pred means. MPS (myofascial pain syndrome) would probably take more than 3 days to ease with 15mg oral pred - but a good physio or sports massage therapist might be able to help. That is my personal preference.

[Navion in reply to PMRpro]

Thanks. It seems like it could be that. I'm a little gun shy though because I have gone to physical therapists and massage therapists for the past year, before being diagnosed, and it always made things worse. However, maybe if they know what's wrong with me now, they would try something different.

[PMRpro Ambassador in reply to Navion]

They must be aware of the limitations PMR sets on physical therapy - and repeated exercises is absolutely the wrong way to go. I expect to feel sore the next day or so - but I've been doing this for a long long time. You are quite right though - you do have to be careful and they have to work on the spasmed muscle and that alone at first. Only once it isn't spasmed can you do anything with physio.

[Soraya_PMR]

Burning pain between shoulder blades: this is an out of the box thought:

After my rib and shoulder and hip pains had abated, I was left with something I called my ‘tired back’. A mild but draining ache between shoulder blades. The chiro helped with many ‘extras’ but this particular one just droned on and on. Until one day I tried something different! I had a 💡moment. Ranitidine! It was a referred pain from indigestion! I mentioned this to another forum member, and it was effective for her too 😁

Might not be, but worth a try?

[Navion in reply to Soraya_PMR]

Thanks. It might be worth a try.

[Hidden in reply to Soraya_PMR]

I can vouch for that as it twas I.

[Navion in reply to Hidden]

Good to know. Thanks.

[Navion in reply to Hidden]

Same question as I asked Soraya PMR. How long before you felt an effect?

[Hidden in reply to Navion]

To be honest I saw Soraya post something about her experience and realised for 2 days I hadn't had pain between the shoulder blades, known to be a symptom of gerd I think. I was 2 or 3 days into the Ranitidine. I ran out 2 days ago and can feel it poking me. I know I have acid reflux and had been on ppi for 15yrs until last year. Got to say Ranitidine works much better. It's worth a try I was taking the 4 in 24 hours that first few days

[Navion in reply to Soraya_PMR]

How long until you felt an effect? I have some here at home left over from treating a severe body wide rash (cause unknown) a few months ago.

[Soraya_PMR in reply to Navion]

Hmm, let me think....

It’s not instant. Gaviscon might provide a quicker (but not sustainable) result. But probably eased by day 2. Takes a while longer if your stomach is inflamed/ulcerated, in this case up to a week at a guess. I was prescribed 150mg twice daily by rheumi, but if I get indigestion +/or the between shoulder blade pain, I might take 75 twice on day one, just 75 day two, and maybe for 4 days in total. I can’t take the higher doses as it causes diarrhoea (for me). You can buy it OTC. I don’t have to take it very often since being on coated pred, maybe once a month? If that.

patient.info/digestive-heal...

I’d disagree with the comment that PPIs are better than H2 blockers (histamine H2 receptor antagonists as we used to call them). I think ranitidine has far fewer side effects, works just as well, but is probably considered ‘old’ by many. Which is good IMO, as long years of use means that there’s not too much that isn’t known about it. A bit like pred.

[PMRpro Ambassador in reply to Soraya_PMR]

PPis are only worshipped because of their superb marketing - the actual difference in effect is negligible. Particularly since PPIs don't work at all for about a third of patients and have more adverse effects ...

[Navion in reply to Soraya_PMR]

Thanks for the info. It's worth a try but I suspect it might be myofacial pain syndrome. I had this pain for several months before I went on prednisone, though, and it also goes into my ribs. Twice I have had horrible muscle spasms that took me to my knees.Also I have never had a history of gi issues and the prednisone doesn't seem to bother my stomach. But since I have some Zantec in my cupboard, I can see if it helps.

[Soraya_PMR in reply to Navion]

Oh yes ribs! Not mentioned often in medical writings on PMR, but comes up quite a lot on here.

[Marilyn1959]

Hi Navion. The pain between the shoulder blades and at base of neck has always proven to be the bane of my PMR journey (alongside under the buttocks). Since the shoulder pain kicks in on every taper my Rheumy has arranged for me to have a scan led pain block injection at the base of my neck, to see if this helps with the localised pain. We are hoping this will allow me to taper easier.

[Navion in reply to Marilyn1959]

I would be very interested in hearing if it helps.

[Marilyn1959 in reply to Navion]

I need to rebook my appointment for the procedure so it may be a while, but will make a note to let you know how it goes.