I read a post regarding PMR and carpal tunnel syndrome. Unfortunately I can't find it again. Is carpal tunnel syndrome related to PMR? At present my left hand has been operated on for carpal tunnel and my right hand recovered once before, but is now at a stage where it probably needs an operation. I've had PMR for 10 years now and I'm on 5mg of pred.
Also, I've been working very hard for the last 9 months and as well as carpal tunnel, I've got pains in both hips, shoulders and hands. Would you advise to increase the pred or do you think it's just hard work causing the pain. I'm asking because I know PMR always comes bilateral. If I should increase the pred, by how much and for how long should I do it for?
Best regards,
Buenavista
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Buenavista
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At higher doses of pred the swelling in carpal tunnel syndrome will be relieved. Overdoing activity can make CT worse and also make PMR flare - but it can also lead to DOMS, delayed onset muscle soreness, and if you continue to push it, the pain never really settle because the tiny tears in muscles that cause it never have time to heal properly.
The only way to find out if more pred helps is to try it.
Thanks for your advice PMRpro, I don't know what I'm going to do next as I've still got a lot of work to do. If I go up on pred, how much do you recommend? And if it doesn't help, do I go back to my usual 5mg or do I have to tapper down slowly?
Only you can find out how much you need to relieve the symptoms. Are you using a wrist splint? And sometimes you have to admit that the work will have to wait. There are no magic answers.
I'm still seeing my physio for the 3rd time of carpal tunnel syndrome. I have a wrist splint now and that helps so much during the night.
I had my vaccination yesterday (Johnson and Johnson), so just 1 injection. No problems at all, but went to bed about 12 ish and woke up at 1:30 with the aches and pains from the last few months of heavy building work, it has taken it's toll (all the usual pains). So I got up at 2:00, had a yoghurt and took 10mg of pred, by 4:00 most of the pain had gone. Went back to bed and this morning we went for our usual walk down the mountain side and back up and still no problems. How would you suggest I proceed now after my rhumey put me on 5mg for the last couple of years. Do I need to take 10mg of pred for the next couple of days or just go straight back to 5mg?
Again, only you can know - better will be less pred rather than more for the immune reaction's benefit so if you can get away with less, do so. But you do have to function!
Interested to read your post and PMRpro response. Having been tipped into PMR a couple of months back (by Pfizer 1 I suspect) my 15mg of Pred brought acute pain gradually under control over 2 weeks - however (as well as the usual fatigue) I am left with some stiffness in the mornings, but quite bad ache and stiffness in wrists and hands, sometimes sticking fingers. Also L shoulder. I’ve had a couple of CT ops on both hands over the years - and torn L shoulder muscle (an old injury which had re-occurred and was awaiting further physio when PMR struck). Symptoms are largely gone by late morning - presumably as Pred takes control?
I’m obvs reluctant to increase Pred - and if I’m understanding PMRpro correctly might it be better to cut back on activity for a few days first to see what happens?
Having been very active I’m finding it very hard to find what a reasonable level of activity might look like - but am frankly frightened at potential damage of over-doing things...
Timing of taking pred is also crucial to morning control of symptoms. A new batch of inflammatory substances is shed in the body at about 4-4.30am and the longer it is after that before the pred takes effect the more inflammation will be created and the longer it will take to clear out. The optimal time to take plain pred is 2am - it achieves its peak in the blood in time to avoid inflammation developing in the first place. Alternatively, waking early, taking the pred and settling down for another couple of hours is also beneficial if you don't want to wake in the middle of the night. Patients in the UK using enteric coated pred find taking it before bed works well - it take 4-5 hours to get into the system - and others obtain acid-resistant capsules to put plain pred into to achieve the same effect.
Activity levels can be assessed by starting very small and building up slowly over a period of weeks: for example, walking a moderate distance that you know you can manage without payback next day in the form of x minutes out and x minutes back. The next day should be a rest day where you assess whether you have done too much. If not, add 1 minute to the walk out and back, i.e. 2 minutes more in total. Repeat the exercise day/ rest day pattern, adding a minute at a time until you get to a rest day where you feel the previous day was a bit too much. Stop there and "train" at the previous day's level for some weeks - then start adding and assessing again.
You can use the same approach for most things - with weights or resistance work start with almost no weights/resistance and do the same with very small increments. Instead of hand weights, start with a couple of water bottles and add a small amount of water to make a weight - for example. do bicep curls with a low number of reps and increase slowly to get to 10 and then split to 2x5 and build up one at a time to get to 2 sets of 10 reps. And so on.
It sounds slow but I promise it isn't because by doing it this way it is next to impossible to overdo it - if you overdo it you have to stop until you recover which takes much longer with PMR than it would normally, sometimes months. If you try to push through it will bite back!
Sorry another question... If I take Pred at 2am what do I do about the instruction to take with food, please? Would a banana and herbal tea suffice ? Or prep a small sandwich / ryvita before going to bed?
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