Guys, asking for advice once more!

[Breconblue]

I have been suffering quite bad neck muscle pain for about 2 weeks, independent from PMR I think. Then on Friday night I experienced the worst pain ever, anywhere, in my right hand side chest muscles ( intercostal) and shoulder. So severe I could hardly breathe, or lie down. My H wanted to call 999, but I knew it was muscular and not worthy of emergency call. After a terrible night, I agreed to go to A and E. When I eventually ( 😚) saw a Dr, he agreed it was muscular, gave me prescription to take home. However. At no point was a medical history taken, or was I asked what meds I was already taking. He gave me Co Dramol, Diazepam,Naproxen and Omeprazol.. I told him I was taking Pred and was it ok to take Naproxen as well.? He said yes, though didn’t ask dose ( I’m on 9.5) . I took all at the hospital and it worked a treat and I walked out. When I got home, and read up about it, it seems taking Nap. And Pred raises chances of bleeding internally but also you need less Prednisolone.. in addition since he didn’t know I was already on Omperazole should I take 40mg instead of 20 mg, indeed should I take Naproxen at all? V confused and drugged up as well! Though most of awful pain gone🤪As it’s Sunday Pharmacy closed to can’t ask for advice . Would any of you very knowledgeable folk be able to advise?

[SnazzyD]

I’m not a doctor but applying a logic hat - With that lot the pain wasn’t standing a chance, you are hitting it with an anti-inflammatory (Nap), an opiate type that hits the pain centres in the brain (Co-Codamol) and a muscle relaxant (Diaz). It was probably a case of, no he’s not dying so let’s hedge our bets and knobble all possible pain types and leave him to seek more detailed diagnosis in the slow lane, because it’s A&E and that’s not our job. So, the good news is, it is you don’t need any of that to stay alive so tinkering with them is ok. Ideally, you need a clean slate to see what is helping and a chat to your GP. I’d ditch the Nap first for the reasons stated. I think the idea of Nap being a steroid sparer I’d take with a pinch of salt, because it isn’t already and anyway you don’t want to be leaping down the dose ladder below 9mg, in tricky adrenal territory. The Diazepam needs to be discussed with a GP because it is habit forming so a short course might be advised to coax muscles out of any spasm. Co-codamol is also habit forming and your intestines will soon be shutting up shop, so again, discuss with the GP a course. If it were me and feeling ok from their side effects I’d take Diaz and Co-co for a few days and stop to see what happens, or stop one of them first for a few days, then the other. I wouldn’t drive either!

[PMRpro Ambassador]

I agree with all Snazzy has said.

Since you are on omeprazole and it is short term use the Nap was probably OK - I was on a week of high dose i.v. NSAIDs last year while on pred but the only instruction from the rheumy was "take a PPI". That was OK but I never want to try that approach again even though it did work! He was surprised I preferred a steroid shot.

Where I do really disagree with your doc though is the Nap will spare pred. No it won't if what you have is PMR! And its side effect profile is as bad as if not worse than pred IMHO. And a doc who doesn't warn of the adverse effects of that cocktail needs some education - opiates should come together with laxatives on the script...

[Christophene]

Naproxen or any non-steroidal anti-inflammatory does not treat PMR; they can also cause gastritis and skin allergies. Before PMR, I took it in prescribed doses for about 10 years due to lower back pain with scoliosis , nerve involvement, and disk problems.

Then the problems started: skin allergy with large blisters on hands, feet with small skin years caused by interaction with sun, and 2 visits to emergency room for gastritis, treated with IV Pepcid and Reglan. After IV Pepcid, immediate relief. I stopped the Naproxen, and problems never came back. But 10 years without pain was a blessing.

Having said that, I doubt a short course will cause any problems. And the Omperazole taken before, should prevent the gastric problem. Non steroidal anti-inflamatories are not benign. In the US, you can buy them in the supermarket ! But I wouldn't take it long term.

My neck hurts too, even with Prednisone, but Tiger Balm ointment does help. I find that some topical ointments for pain work well. Lidocaine patches are my favorite; 4% can be bought over the counter, 5,% requires a prescription, that is in US.

Good luck. I hope your neck pain goes away quickly.