Pain much worse in right arm, after flare

[Neck680]

I was managing well on 5.5-6mg pred/day for about a year (having come down slowly from 15mg for another year), then a flare hit me this April. I went up to 8.5 and stayed there a while, then went step by step down to 6.5-7. Pain was moderate/manageable but slowly my right arm got much worse and worse, and still is. PMR is typically bilateral so this surprises me. Also have a nerve pain going into my neck from right shoulder. I do play tennis with my right arm but I have not felt any negative effects of that for the last two years until now (lucky).

I just went up to 9.5 today to see if the pred will bring down the pain. If it does, I will assume it is just the PMR; if not, I will explore further. Any ideas about the asymmetry?

Thank you for all your wonderful suggestions.

[PMRpro Ambassador]

I would doubt it is directly entirely PMR - although in a flare it can be worse on one side than the other and you do say you have been reducing despite pain. Maybe it is a enough to manage most of the pain but not the worst bits.

My suspicion would be an element of myofascial pain syndrome that is affecting your shoulders in particular

spineuniverse.com/condition....

spine-health.com/video/myof...

are two pretty good offerings about it. MPS is found more in PMR patients than those who don't have it and while the problems are caused by the same inflammatory substances but the difference is that in PMR they are systemic and in MPS they are localised, either in the fascia of the large muscles (the transparent skin that is found around muscles in joints of meat or poultry) or forming knots of hardened muscle fibres in the large muscles called trigger points and often found in pairs on either side of the spine in the shoulders, about rib level and in the low back. These cause the muscle to become tight and can irritate nearby nerves leading to referred pain - bad shoulders spreads to neck and arms. I find that just one simple action can be enough to send the muscles involved into spasm - catching my head getting in the car for example, or trying to rescue myself from a simple trip. One bad move with that tennis raquet ...

[Neck680 in reply to PMRpro]

Thanks PMRpro -

You are always so helpful to my queries, I am in awe of your expertise and wisdom (and sense of humor). Video and article were helpful, thanks, MPS has come up over my last few decades before PMR was a major event. Also fibromyalgia. I will take 9.5 mg for a few days and then drop to 7, see what changes, or perhaps resolves. Sometime MPS is a matter of dispersing that knot, but this time it feels deeper and more consistent. We'll see....with more gratitude, Amy

[PMRpro Ambassador in reply to Neck680]

Not my expertise (although there is too much personal experience for my liking) but the accumulated experiences of thousands on the forums over 12+ years.

[Neck680 in reply to PMRpro]

And I enjoy your modesty- thanks again...

[South123]

Morning. Very strange reading your post. I am in exactly the same place as you.... 2 years in flare in Feb.. . Back to 10mg and now down to 7 with acute pain in my upper arm on the right side. I found going back to 10 did help and I have since gone back to 8 and the pain has returned. I am reluctant to stay at 10mg just to relieve the pain in one area...but I may have to. In the meantime heat seems to work. Hot shower with the water on that spot... heated pads and deep heat cream all help.

[PMRpro Ambassador in reply to South123]

What's the matter with 9mg? The primary reason for a flare is reducing the dose too far or too fast - if 10mg works, 8mg doesn't, try half way, And while it may be one area now, leave it for a few weeks and it is likely to be more as the inflammation builds up.

[South123 in reply to PMRpro]

Yes I will try 9mg and see if it helps.

[Neck680 in reply to South123]

OK - I hear you South123— let’s listen to PMRpro, stay at 9 or 10 and decrease slowly again after some weeks. Amy