I am wondering if I am making tapering more difficult for myself as I am trying to reduce the amount of tramadol I take for my back fractures as they heal, now 4 months in. This idea came to me after a discussion about the old dog's arthritis when one of the vets told my son and his wife that tramadol has anti inflammatory effects.
Further to my post about burning shoulders the rheumatology help line said it couldn't be PMR GCA related and that pain relief was nothing to do with them but I must reduce the prednisolone at 1/2 mg a month. So I managed a phone appointment with a random GP who suggested I increased pregabalin to 100mg split into 2 doses. Apart from me saying that I was then taking the max dose of tramadol we didn't discuss it.
So for now I have stopped trying to reduce tramadol but have gone back to tapering prednisolone slowly.
Anyone else been taking prednisolone, tramadol and pregabalin? If so what are your experiences?
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Cally55
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I have no idea where the vet got their information but Tramadol does not have an antiinflammatory effect, it is not an NSAID (non-steroidal anti-rheumatic drug).
Most people who have taken various opiod painkillers say they have no effect at all on PMR and pregabalin usually won't help PMR pain either - it isn't nerve pain.
But certainly it isn't a good idea to change more than one thing at a time so taper one thing and see what happens. I can't imagine why the helpline said your shoulder pain can't be PMR/GCA related - shoulders are typically part of PMR symptoms and it is mostly due to bursitis. You only continue to reduce pred once all the PMR/GCA pain is managed at the outset. The degree of pain/symptom relief you get with the starting dose is your guide - which is why you need a high enough dose for long enough, you shouldn't then be worse at the end of a reduction step than at the start. And symptoms rule - if any return during a reduction, you have almost certainly either gone too low or you have been doing too much.
And I'm sorry helpline person - but the purpose of the rheumatology management is to achieve pain relief by managing the disease process optimally. It sounds as if it isn't.
That's not all, when I said I felt a bit isolated and was struggling and that my next rheumatologist appointment is the end of October she said snappily that their job wasn't to oversee tapering! As I said to my daughter I should know better by now and should not have tangled with the so called "help" line.
As for the tramadol I am thinking that stiffness and exhaustion are withdrawal symptoms. I have been taking it for about 3 months now so probably addicted to it. The question is which is doing more harm, the prednisolone weakening my bones or the tramadol making me dopey.
I think I must have another attempt to get the GPs to refer me another rheumatologist.
Er- they prescribe the treatment, and that includes the tapering.
Don't believe all the rubbish about pred "weakening" bones. In over 7 years of pred, much of it at above 10mg, my bone density didn't change appreciably.
Complaint time in my book - she may have been having a bad day. Kick the wall - DON'T take it out on an innocent patient. Who put you on the tramadol and the pregabalin? Have you got a sensible GP - as opposed to a random one?
Have you tried lengthening the time between tramadol doses? As opposed to taking less that is. It may help.
Thanks to all of you. I have osteoporosis and 4 spinal fractures and the odd rib. The tramadol was prescribed by GP after the second lot of fractures in March because codeine wasn't enough and the side effects were a bit much. I find tramadol side effects easier to deal with. The pregabalin was prescribed for me,at a lower dose, by the regional specialist I was sent to by current rheumatologist, who decided I had had GCA but not any more and that my scalp tenderness was now something else and would be helped by Gaberpentin or pregabalin, and that it would help my back as well. It made no difference to scalp tenderness but did help my back. Dose has been increased by GP subsequently. The rheumatologist is certain that my osteoporosis is caused by high dose corticosteroids hence the insistence on reducing them. I am on azathioprine as a steroid sparer. I don't know what blood tests they did at the beginning of my treatment as the first rheumatologist, now retired, was the dictatorial sort who didn't think patients should be included in any discussion! I had decided to go elsewhere when i heard he had gone so I thought I'd give the new one a try, not much different kept saying hadn't got GCA, referred me to regional specialist who trained her who said I had had it!
So the tramadol was prescribed for fracture pain but seems to help with the PMR, possibly because reducing one lot of pain just makes me feel better generally.
I have managed to get an appointment with my GP, who happens to be the senior partner, so I shall take my husband with me and see if I can see someone else on NHS. The snag is the appointment is 6 weeks away!
"...kept saying hadn't got GCA, referred me to regional specialist who trained her who said I had had it!"
Exactly the same thing happened to a "PMR-friend" from Kent. Her rheumy was just the same and finally sent her to Dasgupta who said "yes, it probably was GCA..." but no-one would let her have enough pred to manage the symptoms which is a bit pointless. So she travelled to Prof Mackie in Leeds - who picked up on her comment the back pain was earlier in the night than you would expect for PMR. It turned out to be ankylosing spondylitis - which had also caused all the typically GCA symptoms she had had. Reduced blood flow is reduced blood flow - whatever causes it.
If you have such severe osteoporosis, then there are drugs that build bone density that they can use while you are on pred. But you need a competent rheumy who will investigate properly - because I suspect they haven't yet.
Hi cally55, I take pred, tramadol and duloxetine (among other drugs). First reiterate what pmrpro says ....tramadol and pregabalin do not address PMR pain and what a rude "helper". If you need support check your local health authority website. They sometimes run groups for 10weeks that explore chronic illness in general and of course there may be a pmrgcauk group you can go to.
Tramadol....yes you can get withdrawal symptoms. They feel a bit like flu. What dose are you on at the moment? I am on 400mg a day of 50mg prolonged release pills at the moment. If I were tapering I would knock off 1x50mg pill a day for a week and hope I am ok. If so the next week I would drop another 50mg and so on. Hope that helps.
You were just very unlucky to get the most unhelpful helpline operative on the day!
You poor thing !
But don't worry , you are not alone , you may need to deal with the doctors to figure this out but you can always come on the forum for advice , a chat or a rant and we will support you.
My Rheumatologist said, “ my rheumatology nurse will oversee your tapering. “ I have to have a blood test a few days before seeing her so that she can look at the CRP. As for the ‘helpline’ .....never found it very helpful. They are supposed to get back to you within 48 hours but sometimes don’t. Whatever your problem is has to be relayed from the nurse to the rheumatologist so it’s another 24 hours before advice can be given. It is a non urgent helpline and it does say to consult a GP if your problem is an urgent one.
Goodness, what a lot of misinformation for a complicated situation. I’m not sure Pred is the one to be reducing because if your shoulder pain is PMR, which is very likely, you will lose control of the inflammation. Withdrawal can give you aches and pains so it may well confuse the issue. Tramadol is an opioid and not an anti inflammatory and very habit forming. Also you can get rebound pain from it so you become hypersensitive. My next door neighbour broke her back and found it quite difficult to wean herself off but did so eventually with a weaning program once she realised that she didn’t really need them for pain that was able to be controlled by another type of pain killer.
Thank you, I gather that tramadol is hard to kick, my daughter in law takes it for knee pain and left over pain from cancer and does not seem to to think she will ever give it up. I have an appointment with a pain management clinic in August so I shall ask them what to do then. I have tried reducing it from 8 50mg a day to 7 one day and 8 the next with the results above.
From reading this forum shoulder pain seems to be very much PMR and GCA, also when I got down to 8.5 pred, now on 10 going down to 9.5 , heart palpitations, tongue pain and jaw aches returned.
That’s good you’re going to the pain clinic. All habits and addictions are hard to kick but I doesn’t mean it’s not possible, though prescribed plans are often more optimistic than people can cope with so they give up. All it needs is a more realistic plan per individual. It would be great for you to have a clearer picture of what’s going on with fewer powerful drugs going in, but if you have to have them, you have to have them. However, Pred is more than just a pain killer.
I think if you want a clearer picture you do need to taper one thing at a time. Psychologically as much as physically. You are asking your brain the equivalent of stopping smoking, stopping drinking and going on a 800 cal a day diet! The pred you know you need and it sounds like you need to go back to a slightly higher dose. I DO NOT recommend stopping tramadol cold turkey, I have done it several times to break down tolerances. Its not good. You could even try 1 pill down every 2 weeks. It's only been 3 months so even though you will be dependent if you don't think too much about it it's not habitual as I see it (15yrs down the line). It sounds daft but you can take paracetamol to help with withdrawal. I occasionally don't need my full dose for pain so drop a couple of pills a day for a week or two without much trouble really. Good luck and if your pain clinic experience is like mine it was very good. I got access to therapy, physio and of course the pain whisperers..anesthesiologist.
I think i am actually looking forward to the pain clinic, usually I am not keen on medical appointments. After a little while tying up roses blown down in the storms my back is really painful, I think I shall leave the tramadol reduction for now and try dead slow nearly stop with the pred, more stop than slow probably.
I think I would wait for pain clinic anyway really. It's good to get the support. I hope I haven't built it up too much 😂😂😂 I t did keep me at work for a few years longer using the techniques from there. But you never know what you are getting with the NHS these days.
Sounds like tramadol withdrawal to me. lengthen out the time between doses till twice a day then reduce dose. Far less in way of withdrawals that way in my experience.
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