Tired and stiff with a normal ESR

[Seraphina56]

Hi. I think I need a bit of help. I tapered from 10 to 9 mg of pred over the 26 days slow taper and have been on 9 for two weeks. Stiffness and aches have increased but the worst is overwhelming tiredness all day long. I’m dragging myself around. GP did a barrage of bloods which receptionist just told me are all normal. Could this still be a flare? Am I looking at upping the pred to 14 for a couple of days then back to 10. I am also two and a half weeks off Tramadol and wondering whether it could be withdrawal from that if not PMR. Advice would be helpful. Thank you so much.

[DorsetLady PMRGCAuk volunteer]

Certainly sounds like a flare - not sure about the Tramadol - never taken it.

Did the problems only start once you got to 9mg or during the taper?

If during taper you can always put on hold and repeat previous week - don’t just plough on.

Whatever would suggest you try a 0.5mg reduction instead of 1mg in future.

I would try 14mg for 5 days - then down to 10mg.

Bloods may still be okay - but they very often lag behind symptoms - so always go by symptoms.

.

[PMRpro Ambassador]

What does "normal" mean? The range quoted is not for a single person - it is the levels found amongst 95% of a large population of healthy people, often 10,000 or more. If your personal normal level is in low single figures, the ESR can go up to upper teens which is obviously high for you, but still "within normal range" accordng to the lab. So you need to know how low you got on higher doses of pred and look for the trends.

But often people still on pred don't develop the response that makes that figure rise until very late in a flare, it can be as much as 6 months behind there being symptoms.

[Seraphina56 in reply to PMRpro]

Thank you for this. I couldn’t get the receptionist to tell me the actual result but I’m hoping to speak to a doctor tomorrow so should get it then. What you say underlines the importance of having regular blood tests for comparison; unfortunately sadly lacking with my GPS.

[diana1998 in reply to Seraphina56]

I always get a print out of my bloods from surgery so I have a record. Otherwise receptionist just says 'Normal, no action' and one hasn't a clue.

[Rimmy]

Tramadol is a pretty major pain killer so whatever pain it was intended for might re-emerge although assuming it was not prescribed for PMR. As DL suggests symptoms inevitably trump everything else regardless of blood test results or even Pred dose -if you are not getting 'enough' that is. Many of us here at some stage will have had the frustrations of doing what we think is a 'slow taper' and regardless still having return symptoms or a flare. Basically you need what you need to control the inflammation and this can sometimes vacillate without warning.

Best wishes

[DorsetLady PMRGCAuk volunteer in reply to Rimmy]

SJ?

[Rimmy in reply to DorsetLady]

Ha ha - apologies I meant YOU of course DL (duly edited) - I must have been off with the 'pixies' or was it the Pred .... X

[DorsetLady PMRGCAuk volunteer in reply to Rimmy]

could be anything! I knew who you meant, just being pernickety. 🤣😂

[tangocharlie]

My CRP was almost normal at 6 last Friday, and on Monday it had risen to 16 in just 2 days. But I have been still fealing sh*t even last week until the Drs upped my Pred again this week. So although my symptoms are generally responsive to Pred I go more by how my body feels. I only ever took Tramadol for two days a few years ago for a frozen shoulder, never again, it didn't even reduce pain and I had 'out of body experiences' and very horrible nightmares, it's an opioid isn't it and very addictive? So I can imagine there would be adjustments coming off it if you've been on it a while, it's a very strong drug.

[Seraphina56]

Yes I took the Tramadol for shingles pain I had for two weeks but it took four months to get off it because of withdrawal symptoms. What you say about your CRP is very helpful. Thank you

[yorkieme]

I am unable to add to the comments below regarding the impact of Tramadol on PMR due to lack of experience but I did recently withdraw from Tramadol.(February this year,) While abroad they were prescribed in slow and fast acting versions and to be quite frank they turned out to be very scary.

My wife often heard me having a conversation with myself during the night but there were other bad side effects including and shockingly suicidal thoughts but the main point is that they do take considerable time to come off and tiredness/lethargy was a big one for me.

Not sure this helps but I wouldn't completely discount it. Hope it improves.

[piglette in reply to yorkieme]

Hallucinations can be one of the side effects.

[Seraphina56 in reply to yorkieme]

Thank you for this. I did the slowest possible taper off the Tramadol and the docs usually say at most 7/10 days after last dose for withdrawal symptoms to exist, and my last Tramadol was 19 days ago. But I take your point and these estimates of effect are often wildly underestimated. The tiredness is the thing they have in common. The pain and stiffness could only be PMR. I am also quite tearful which is usually Tramadol withdrawal. I think I’ll probably up the Pred. Will check it out with Dr tomorrow with more detailed blood results.