Diagnosis Advice

[vosadrian]

Hi All,

I joined this forum mid last year as I was struggling with some issues and thought PMR could possibly explain it. I did a lot of research here and then saw my doctor who did not think it would be PMR but gave me a script for Prednisolone. I had one package of 5mg tablets. I think I did about 10 days at 15mg and then tapered off with no noticed benefit, so I then gave up on the PMR diagnosis and pursued other options... but I am back wondering if I covered it fully.

I probably don't have it for the following reasons:

* I am 46 (too young??)

* I tried prednisilone 15mg for around 10 days with no positive response (I believe this is diagnostic)

* Inflammatory markers (ESR/CRP) in blood tests are always good

But I have the following symptoms:

* Painful jaw on both sides but more on right. I had wisdom teeth removed 3 months ago as I had recurring infections in one and thought that could explain pain. No more tooth infections, but jaw pain no better. The jaw feels tight and I have reduced jaw opening range and in cold conditions I actually have trouble talking making certain sounds due to jaw limitations.

* Pain more on right in neck/check/into ears and down into shoulders and upper back. Sometimes feels like something is caught in my throat. Seems to be worse when jaw is worse. Best in morning, but gets worse as day goes on. Feels like glands are swollen and sore, but anti-inflammatories and antibiotics do not seem to help.

* Sometimes when things are worst (1-2 days of every 1-2 weeks), I get headaches seeming to originate from right forehead/temple area and my right eye gets fuzzy. I can still see with it, and no loss of vision as such. Just find myself blinking and double taking and struggle to focus.

* I also have other chronic pain issues in lower back/hips, but not sure if they relate. Have been tested by Rheumatologist previously for AS/RA and tried some meds including MTX with no benefit to that so concluded mechanical origin.

So I probably don't have PMR, but perhaps people here have been down a simialr path to me and found what they did have and could provide alternative things I should ask my doctor about (since he has no further ideas).

I should note, I am very active despite this. I do a lot of cycling and push through the back and hip pain , so have excellent general fitness. I am limited in function, but I can generally push through pain/tightness/inflexibility to get tasks done I need to do (like work), but it is just much more difficult and at the end of the day I just want to collapse lying down in front of the TV. I dream of doing something (anything!!) in comfort like I used to, but I don't seem to be suffering at the level many here seem to.

Thanks!

[SnazzyD]

Just a quick fire reply on one point for the moment, not considering any other evidence of yours. My daughter had to have extensive dental treatment and due to having her mouth open wide for an extended period ended up with big problems. Her temporomandibular joint was upset, she had severe, headaches, jaw and neck pain. A couple of trips to the the osteopath and some cranial work sorted it out nicely.

[PMRpro Ambassador]

My suggestion would be to investigate myofascial pain syndrome and TMJ as Snazzy suggests.

The balance of the back muscles to keep us upright is a delicate one - if something upsets that balance they may tighten to protect themselves from further damage or pain and then it can be a progressive pathway. Whiplash injury is a well-known situation but something as simple as hitting your head getting in or out of the car can start it off. Tightness in the shoulders can result in effects on the local nerves - leading to pain into and up the neck, even affecting the top of the head. And it can spread downwards as well leading to low back pain - that is the pattern that occurred originally for me. Shoulders first almost always. Posture DOES have something to do with it - but as the pain clinic specialist here says - you adopt the posture that hurts least, it is not the underlying cause of your problems.

spine-health.com/glossary/m...

and look at the other links the mention on the page.

It has 2 effects: it forms trigger points which are concentrations of the same inflammatory substances as PMR and can be felt as knots in the large muscles, usually in pairs on either side of the spine in the shoulders, at just below rib height (in the lats) and in the low back where the baby's dimples are, and it also involves the muscle fascia, the transparent skin you will be familiar with from joints of meat or poultry. It too can become inflamed and causes a more diffuse tenderness over the muscle group.

I searched "myofascial pain syndrome spine health" - and there were a lot of interesting articles I would investigate but too many for me to list here.

[SnazzyD]

Also, something I wheel out with wearying regularity but it could be very relevant to you, especially with the cycling and dental work- sternocleidomastoid problems.

healthline.com/health/stern...

[vosadrian]

Thanks for the comments!

I should have noted that I am seeing an Osteopath for the last 6 weeks or so. He has done a lot of work on the upper rib cage, shoulders and neck and jaw. I feel better after seeing him, but it has so far been temporary. He thinks something else may be going on and I have seen my GP, but he is reluctant to aid in further tests. It would put my mind at rest to do a scan of some type and check if everything looks OK.

Is there anything else I could be doing? I feel the Osteo is a good one. He has helped me with my Hips/Pelvis before and helps other family members a lot... I think I am just a tough nut to crack.

[LIVEORDIEHEREIAM]

vosadrian, if you have spent any time at all on this forum, you know to be ever watchful for visual disturbances that could be a sign of GCA. The low dose you were given as a test would not even touch that, but would have been helpful for PMR symptoms.

I wouldn't bother to post this but you made no mention of the GCA connection and the resulting possible blindness is nothing to trifle with!

Please be safe and keep trying!

[vosadrian]

Thanks LIVEORDIEHEREIAM,

Yeah, I am aware of that link with GCA. It certainly concerns me. I guess at the moment, I tried the Pred for a period with no change to anything and that has been the diagnostic test. I'm not sure if my visual disturbances are the type that are typical of GCA. In the absence of a doctor who is very helpful to guide me, what is the next step in checking for this? Higher dosage Pred?

[Italianfemale]

Are you grinding your teeth? Your symptoms sound like mine. I hsve been prescribed muscle relaxers and go to therapy. Advised to take mirin for anti inflammatory purposes in those tissues. It helps but I am still suffering

[Rugger in reply to Italianfemale]

Did you notice that you've replied to a post that's 4 years old? No problem if it helps someone this year!