Many of you know my history of multiple health issues. I've been on Actemra off & on (mostly on) since early 2020. Discontinued prednisone July 2021. Braces on knees, walking helps lower back, P.T. & pain rx is all helping, except nothing helps pain in both shoulders and arms. I do have mild/moderate pain in both hips too but it gets better as I get moving each day. The burning pain in shoulders/arms is so bad & nothing I'm doing helps that. Rheumy says my significant ddd, herniated discs and stenosis is cause of pain and not PMR. He wants me to do epidural injection in c4c5c6 as this is where most foraminal narrowing is. Does this sound right? The pain is constant and evenly painful both shoulders and arms. I know high dose prednisone covered up a lot of pain from neck & back issues but really reluctant to get ejection into spine. I'm doing so much better in most areas I don't want to make anything worse.
PMR pain vs DDD pain: Many of you know my history... - PMRGCAuk
PMR pain vs DDD pain
I assume your rheumy would not give you say 15mg - 20mg of steroids for a weeks trial?? You sound as if you really are in a bad way at the moment.
I asked him but he said he's sure it's my back, and the prednisone for so long covered up the pain. It sure did because my back and shoulders and arms didn't hurt. Says prednisone has too many risks if not needed for PMR OR GCA.
You could go on at him, but I know the problem of fighting.
Hi Spanky2019, sorry to hear about your issues! I have DDD as well (cervical spondylosis C4-C7), although my symptoms are only mild to medium. When my PMR was at it worse, for me, the difference between PMR and DDD was mostly in the neck muscles (with PMR). At one point I could only turn my head about an inch in either direction. I agree with you about the masking of DDD while on higher dose of Pred. Just today I was doing my morning walk, and I could feel stiffness in my neck, and had to think if it was DDD or PMR. After thinking about it for a bit, I felt for sure it was DDD. I'm currently on 8mg Pred. By the time I finished my walk, the stiffness was pretty much gone, and hasn't bothered my for the rest of the day. Sorry, I've never experienced the type of pain in the shoulders, and down the arms from DDD, and not down the arms with PRM either (just neck, shoulder, biceps). In the past when I've talked to my GP about DDD, he encouraged neck exercises, mostly to avoid surgery in the future. Injections might be the best option for now, but I would do some research first (not necessarily related to PMR).
Thank you. Hard to sort things (as the English say).
I've had cervical epidurals in the same area....ended up with a fusion which solved the problem. My left arm hurt worse and when I woke up I asked the surgeon if he amputated that arm because I had NO pain. (Stupid things we say when medicated!!) Years ago they would blindly insert the needle so it didn't always get to the most effective area....now they insert a little dye and use ultrasound to get the needle to the exact spot.....it is pretty incredible. They medicate you a little in an IV so you are calm and don't feel pain. I'm a retired RN and the procedure is so much better these days than 20 years ago.
So the benefits outweigh the risks as far as your experience?
Definitely!
Hi again. Just curious. Orthopedist called the procedure intralaminar epidural cortizone injection. I know everyone's outcome can be different but, if you don't mind me asking is that the name of what you had success with?
My last one has been about 10 years I think and I'm pretty certain it was a translaminar epidural. So I researched and found an abstract from a medical article which explains it. The idea is that there is more than one way to get to the area and it depends on where the nerve pain is distributed. The article is for continuing education from "Interlaminar Epidural Injection" by Bradley R. Hakim; Sunil Munakomi. Last Update: August 9, 2021. Epidural spinal injections can be administered via a translaminar or transforaminal route, depending on the clinical scenario. When it is more desirable to target a specific nerve root, a transforaminal approach is typically used, and when the target is more diffuse, a translaminar method is chosen. Both are commonly used and can be utilized similarly in the lumbar or cervical spine. However, it is essential that the clinician understand the risks and benefits of these injections. In the lumbar spine, both translaminar epidural steroid injections (TLESI) and transforaminal epidural steroid injections (TFESI) have been shown to provide up to 6 months of pain relief, though long-term benefits are less reliable. In the cervical spine, translaminar injections may provide longer relief and have a lower complication rate than cervical transforaminal injections. Proper technique is essential to the rate of these rare but occasionally severe complications.
I hope this helps!
Yes, thank you so very much. I'm going to schedule this. I had it scheduled awhile back but chickened out. As I said earlier, in many ways I'm doing better. This procedure may just get my pain level more tolerable. I do have pain RX but use them very judiciously. I'll let everyone knows how this goes. Again, thank you and have a good night.
I think the procedure is so much more fine-tuned now, I wouldn't hesitate. When they used to do it blindly it was a tad nerve wracking. I'm in the US and the doctor who would do them was from Ireland and would sing Irish songs. They didn't give relaxing meds then but the music pleased me. Now they give you a little medication to 'zone' out briefly (Versed)....you need a driver because of that.
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