Flare

[Robinsnest72]

Am doing slow taper and just got to 4&1/2. My neck is hurting dreadfully. Is this a flare or steroid withdrawal?

[PMRCanada]

It’s sometimes difficult between the two. Or DOMS?? I find steroid withdrawal happens directly after the reduced dose (usually within the first week). If I’ve lowered to much and flare, my original symptoms slowly return awhile after I’ve lowered my dose. If your ESR and CRP are accurate and follow your symptoms, they can be a clue. Also take note if you’ve overdone physical activity...that can cause pain/soreness that takes awhile to resolve.

I usually give the re-emergence of symptoms a few days to eliminate steroid withdrawal at the beginning of a taper. If Tylenol provides relief, it’s likely not PMR related.

Good luck.

[Robinsnest72 in reply to PMRCanada]

Thanks, I am going for blood work tomorrow. That may tell.

[piglette]

As PMRCanada says steroid withdrawal happens in the first few days after reducing while a flare usually takes a couple of weeks.

[DorsetLady PMRGCAuk volunteer]

When you say you are doing a slow taper, do you mean you are following DSNS, my slow taper or similar?

If so, then they are designed to stop the steroid withdrawal issue.

If not, then as others advised SW comes on immediately at new lower dose and lasts 2-4 days, a flare can take anything up to 2 weeks to surface.

Don’t assume bloods will tell you, they very often lag behind symptoms.

[PMRpro Ambassador]

If you are doing the DSNS approach it shouldn't be steroid withdrawal, the concept was developed to reduce the way your body reacts to the change in dose (which is what steroid withdrawal is) by introducing the change just one day at a time at first. At this level you are looking at your adrenal function returning but that isn't really the same thing and it shouldn't cause localised pain like that.

I have myofascial pain syndrome as part of the PMR and that responds to higher doses of pred. As I reduce the dose I often find the back/shoulder muscle tightness increases and then it really doesn't take a lot for a draught or lifting something or twisting awkwardly to make a muscle even tighter and cause pain. Shoulders affect up into the neck as well.

And DL said the rest ...

[SheffieldJane]

Do you have any Osteoarthritis in the neck? My Cervical Spondylosis takes its turn in producing neck and occipital pain.

[Robinsnest72 in reply to SheffieldJane]

I do have osteoarthritis but I do not know if I have it in my neck. It is mainly my hands. I belong to an exercise class and I only go twice a week. This week only once. I wondered if any of the exercises are aggravating my neck? It seems to be a bit better today. Had blood work done and will read in morning. Thanks for your reply.

[SheffieldJane]

You may wish to request an X Ray, just to find out if OA in your upper spine is playing a part. The pain can be severe and in me, triggered by small things like firm hotel pillows.

[Robinsnest72 in reply to SheffieldJane]

Good plan. I will do that and then you know. I just checked my blood work and it came back excellent. I cannot help but think my neck hanging over with this iPad is also causing pain. I will continue to stay at 4mg for a while. I do think my adrenals are also causing grief. Thanks again. It is snowing again. No rest for the wicked ha ha