Severe lower back pain - can it be a PMR flare?

[JoDo43]

About a week ago I experienced severe lower back pain, especially when trying to get out of bed during the night, when I had really painful spasms. A GP diagnosed muscular strain and prescribed painkillers, but the pain persists. Can it be a PMR flare when it’s in the lower spine mainly and only slightly into the hips? I was sure it felt different, but it is not getting better. Has anyone had a similar experience?

[Blearyeyed]

Did the GP do a physical examination to diagnose the back strain?

Which pain killer did he put you on?

it could be that the back strain is triggering some more PMR activity but back strains can take time to respond to treatment and heal too, it can also be worse in cold weather because of the added stiffness it causes in your movement.

Was there anything that you did that you remember that might have caused a muscle strain in your back?

If you haven't done so already you may need to reduce your physical activity for a while giving it time to recover, especially keeping away from things like vacuuming and activities that involve you bending up and down.

A heat pad on the area through the day will also give some relief.

A muscle relief gel or cream applied a few times a day may also improve the pain as it heals.

if those changes don't help and the pain killer isn't working the GP should be able to prescribe something else or investigate further.

If it feels like your PMR is also being flared by the back issue after that speak to the GP about a temporary increase in your steroids to hopefully clear the added symptoms.

[JoDo43 in reply to Blearyeyed]

I had only a phone appointment with a GP and the only painkiller I can take is Paracetamol, so I’m a bit limited there. I reduced my exercise (Tai Chi) a bit, partly due to the weather, as I have got used to practicing outdoors. Heat did not really help, either a hot shower or gel with Wintergreen or Ibuprofen. The GP prescribed codeine for the night, but it still hasn’t arrived from the pharmacy although ordered on Monday. I have bone marrow failure and am still shielding due to an immune system suppressed by medication. In the end I took a further 5 mg of Prednisolone yesterday evening and there was definitely some relief both overnight and during today.

Usually I tend to rely on 111 online, but I definitely did not want to end up in A&E in the present COVID situation. Thanks for replying to my plea!

[PMRpro Ambassador]

Frequently - and in my case it is due to myofascial pain syndrome combined with sacroiliitis which is made worse by the muscle spasm due to the MPS. I doubt it is muscle STRAIN but muscle spasm - my emergency solution is a flooding dose of 800mg ibuprofen and a hot water bttle over the painful area. I had a wonderful rheumy appt on Tuesday - where he set to with a technique called needling for the muscles and steroid injections into the sacroiliac area. I can feel the difference after nearly 2 years of Covid and lack of my Pain Clinic sessions. Unfortunately I doubt it is availble in the UK but the hot water bottle approach will probably help a lot!

[SheffieldJane in reply to PMRpro]

What a gem he sounds. I get this too now. X

[PMRpro Ambassador in reply to SheffieldJane]

I think it is pretty common, especially in longer term cases. I had it before PMR so I think it is also a case of PMR going for the week spots. But Claire Owen's editorial about the fundamental pathology of PMR being musculotendinous inflammation fits with it too

[Viv54 in reply to PMRpro]

Good to hear 🌷