PMRPro, do you know what triggers your back episodes? Do you increase your prednisone or just ride it out?
I started prednisone a year ago and have been back pain free for a year so this episode is a shock. Prior to that, neck, shoulder and upper back pain and other PMR issues ruled my life.
At first I thought this might be a kidney infection but doctor said no. By now I have tried everything and am still in acute pain and spasm.
Even though it is 1:17 AM here, I think l need to go ahead and take the additional 2 mg of prednisone to bring myself up to 12 from 10. I am not going to be able to sleep if these spasms don’t let up but would gladly trade insomnia for some relief.
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Anniegal
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Hi anniegal, I am no pmrpro but am no stranger to back spasms and back pain. Personally, and I believe from previous threads pro would agree, if the dr has cleared significant issues with kidneys etc and you have no gi issues , I would take a blast 0f 800mg ibuprofen. If this helps, it often takes that unbearable Yikes (polite version) out of the equation for a while until you can fully identify the issue and whether you need xrays etc.
See how the pred does as I wouldn't take extra pred and ibuprofen together. Also, if you are stuck and cannot walk forwards due to spasm pain, then take a step or three backwards and breathe at the same time. Good luck🤞.
Thanks so much. I really appreciate these suggestions. I have a great pain specialist. I respond well to nerve blocks and prior to my PMR dx, would get facet radio ablation done to my lower back and neck every six months. The only trunk pain I have had since being on prednisone was costochondritis. This feels similar but is my right flank. I am not allowed to take n-saids but do have scrip for opiates and a muscle relaxer. I am hoping my osteoporosis is stable and hasn’t progressed. Trying not to get discouraged or to worry unnecessarily.
Having had costochondritis a couple of times I sympathise. I hope you can get at least the edges smoothed out. I take opiaites and have been on amitryipline, duloxetine and not gabapentin for nerve pain in back, legs and neck. Just look forward d to the relief and try as much distraction as possible. This will pass once you get the right combination of investigations and treatment balanced again.
Facet radio ablation - i never heard of that and in a real bad way at the present waiting on steroid injections for low back. Is this a newish thing? Thank you.
"Myofascial pain syndrome leading to tight back muscles - and then something, maybe even just leaning forwards or lying in the wrong position in bed, is enough to send those muscles into spasm to protect themselves. The Pain Clinic uses muscle relaxant injections which are brilliant. If I can catch it early enough therapeutic massage and manual release of the trigger points will avert the nastier episodes.
I had a short attack last week - 800mg ibuprofen in a single dose relieved the agony well enough to finish the job with a hot water bottle. Heat alone hadn't worked. The 800mg ibuprofen lasted almost 24 hours and the next day 400mg was plenty - and it hasn't returned."
I shouldn't use NSAIDs either although my rheumy has used a course of i.v. NSAIDs for this. It seems a bit excessive when just one 800mg ibuprofen works! I think the lignocaine used in a needling technique by the Pain Clinic is the best thing I have overall. It is an ongoing thing though as she won't use steroid shots for the trigger points as I'm on anticoagulant therapy - her predecessor was happy enough to do it though.
Your situation mirrors my own. Looking back I realize I moved some heavy storage boxes earlier this week which probably triggered this. I am also on anticoagulant (Plavix). I love my pain doctor but he is 1 1/2 hours away and these spasms make driving impossible.
I am just home from my second trip to urgent care and this time , diazepam 10 mg is what the same physician prescribed.
I have now taken 10 mg and am in bed with my knees bent and elevated and a heating pad across my lower back.
The urgent care doctor is reluctant to have me use an anti-inflammatory because of my being on prednisone but if the diazepam doesn’t do the trick, that will be next along with an extra dose of prilosec to protect my stomach.
Thanks so much for the excellent and compassionate coaching. I woke myself up screaming in my sleep several times last night from pain .... not fun!
It would be scary and funny to have a recording of the swearing and creaking of us getting up. All of us on the forum I mean. Like the armed forces choir...
Yesterday, my husband drove me three hours roundtrip to see new rheumatologist (useless) and my pain specialist of several years (always helpful).
Later ordered x-rays and gave me prescribed for opiates that have no NSAIDs or Tylenol. Gave me shot of Toradol. This is an injectable NSAID that spares GI tract.
Had to go to ER today pain was so bad. Turns out Yesterday’s Xrays show l have a spinal fracture at T-11. (Thoracic fracture advice most appreciated. )
Today at ER got second Toradol injection.
Good news is my A1C is still at 5.9 and rest oXRay report suggests osteopenia but not osteoporosis. I will find out more tomorrow. My kidney function is fine. Hard not to be miffed that immediate care doc didn’t take XRays to rule out fracture a week ago.
Sometimes they can gaslight you a bit by fobbing you off. I know they don't want to xray you for every twinge but we are often a very hardy bunch with pmr and gca. Pushing through work, personal lives and pain thinking we cant take a moment. Very glad you got a reason for the pain and some pain relief. Tylenol on its own is OK and can keep opiate dose slightly lower if you ensure you take both in a structured way. Don't wait for pain to flare, ever in the next couple of weeks... take them in the 4 to 6 hour alternate cycle. Eg. 8am opiate, 10am Tylenol, 1pm opiate 2-3pm Tylenol.... And so on. Obviously that depends on opiate prescription advice. I would always take the full max dose of Tylenol for a week. Hers just a little link.. Hope you feel better soon.
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