PMR pain due to stress

[Henrynumber3engine]

I was diagnosed with PMR in mid May. I was prescribed 15mg Prednisolone and it was miraculous. The pain disappeared really quickly and I feel 'normal'. I have successfully tapered to 12.5mg and have been on this dose for the last 4 weeks with no further symptoms until this week. This week has been really stressful - I can feel the stress in my body and, lo and behold, this morning I woke with stiffness in my back, knees and shoulders. Don't get me wrong, it is nothing like my pre prednisolone pain but it's enough that I am aware of it all the time.

Can I just sit it out and see what happens, or should I ring the doctor for a chat and up my dose for a few days? (I am supposed to reduce the dose again in a week's time).

Thanks for reading.

[Mary63]

I would say wait and see if things settle. But don’t even think of a reduction until you are sure things are ok again. Is the stress over? As PMR and stress are really not good bedfellows. You may need to stay at 12.5 for longer than planned if the stress is ongoing.

What is your next suggested reduction? Going on what has happened this week a reduction to 10mg might not work for you. I went 15, 12.5, 11, 10.

Good luck and I hope the stressful stuff reduces.

[Henrynumber3engine in reply to Mary63]

Hopefully the stress should reduce over the next week (my daughter is having panic attacks about going to school for end of year tests and school ends next week). I am trying not to take on her stress but I can feel that I am holding it in my body.

I don't know what the doctor's plan is for the next reduction so I will talk that through with her too. Thanks for the advice.

[DorsetLady PMRGCAuk volunteer in reply to Henrynumber3engine]

If you know you are feeling stressed, it might be wise to take an extra mg for a few days..and see if that helps.

If you could be sure that the issue would resolve itself I’d normally say just have a few days chilling out - but not sure that’s going to happen - and the last thing you want it to let it run out of control.

And, definitely no reducing for the moment....and not until you back on an even keel.

[Blossom20 in reply to DorsetLady]

Hi, that's what I was wondering - so you can take an extra 1 or 2 mg if you feel things are becoming unstable? After 3 weeks on 15mg I now have new pain in one hip and my muscles feel like lead when I go out. I'm wondering whether to take more or just not do much. I've got a stressful day tomorrow !

Thanks for your help

[PMRpro Ambassador in reply to Blossom20]

Never be tempted to take more pred without good reason - the pacing part of management of PMR is just as important as the pills. It has no adverse effects in the long term.

[Blossom20 in reply to PMRpro]

Not sure if I understand...'the pacing part of pmr..' Are you saying you shouldnt go up and down willy nilly but stay with the dose for a while?

[PMRpro Ambassador in reply to Blossom20]

No, you shouldn't use pred as if it were a painkiller to allow you to do more. You start on a higher dose than you will need and then taper it slowly and steadily to find your goal: the lowest dose that gives the same relief as the starting dose did. But do all you can to avoid getting into a yoyo habit with the dose because once you do you risk being in trouble, it can become increasingly difficult to reduce that dose.

healthunlocked.com/pmrgcauk......

[Blossom20 in reply to PMRpro]

Thanks, yes that makes sense. I don't even know if my new pains and heaviness are pmr. It feels like I'm fighting off a cold....but have I got any immunity to fight it??

I've got the dentist again tomorrow and will have to have an injection. How will my poor body cope with that?

Keep positive! I'll be fine!

[PMRpro Ambassador in reply to Blossom20]

I've been on pred for 11 years, much of it at above 10mg, I have fewer colds and I had root treatment a year or so ago without any trouble at all.

But remember to make sure the dentist knows you are on pred. The dose you are on at present should be plenty for all but the really bad events - it is above the amount your body needs to function so there is less need to increase the dose for such things.

[Blossom20 in reply to PMRpro]

Thanks, that's good to know

[Blossom20 in reply to PMRpro]

Dentist done! No injection, he just patched it up. I feel such a relief now that's over. Also agreed with the doc to taper 1mg a week! I'll start next week. Thanks for your support.

[PMRpro Ambassador in reply to Blossom20]

1mg a week is very fast - you don't have time to know if it is still enough. Why are they always in such a hurry...

[Blossom20 in reply to PMRpro]

Oh! I thought that was a good compromise- he wanted me to go straight to 12.5 at first. I'm sure he'll let me do it slower if that's what you advise....what do you think, 1mg less a fortnight?

[PMRpro Ambassador in reply to Blossom20]

Reducing at a rate of more than 1mg per month is said by some experts to be predictive of relapse. Personally, I'd say 2.5mg every 4 weeks would be about right if you can cope (some can't) and also using one of the slowed tapers we go on about:

healthunlocked.com/pmrgcauk...

is one. I would have given the Pinned post link with all the options in it but the "see all" has disappeared.

[DorsetLady PMRGCAuk volunteer in reply to Blossom20]

You can increase slightly if you know you are going to have a very stressful time - but it’s not something that should be done regularly.

And we would recommend that you try and manage things without - but it’s not always possible.

For example, I took extra when I flew from UK to NZ return - and would recommend others to do same.

[Blossom20 in reply to DorsetLady]

Thanks. Only dentist stress, I'll be ok!

[DorsetLady PMRGCAuk volunteer in reply to Blossom20]

Ok, well I should try without then. Just try and relax - as much as you can - beforehand, 😊

[ignatz in reply to Blossom20]

After 2.5 years of determined tapering, I have decided to simply go back up to control pain, aches, and/or exhaustion aka 'brain fog'. Will keep the group posted.

[ignatz in reply to Mary63]

I read advice that it is best to reduce at most by 10% per step..... so 12.5mg minus 1.25mg = 11.25mg. rounded up to 11.5mg? Alternate days at 12 and 11mg until all pain controlled.

Good luck.

[PMRpro Ambassador]

Well definitely don't reduce next week - not until you are improved to where you were before. PMR and stress don't play well together - I have had repeated flares in the last 18 months or so despite being on a decent dose of pred, rarely particularly long but always associated with another hurdle that had to be dealt with. Often the worst aspect of the stress as you are describing it is that you are holding your entire body in fight or flight mode - and the muscles don't like it, tighten even further and it hurts ...

[Viv54 in reply to PMRpro]

What a great reply, this is me ! Ihave the awful habit of tensing my neck when im stressed ! I cant tell you how relieved i am to have found this forum. I have a great family and kind friends , but i had no idea really about PMR, so when it came round for a second time ,to say i was shocked was a under statement !! At last people who get it !!! Thanks everyone xxx