Is this a sensible course of action?

[Jontie]

I've posted about this before, but the saga continues. In brief: Since the beginning of December I've had neck pain on the left side when turning head to right. On Christmas eve crp was 27 so I increased from 3mg to 5 for 2 weeks. Crp and neck pain unchanged. Then increased to 10mg for 2 weeks - crp down to 6, neck pain persists, dropped to 7.5mg and then 5mg.

Actually managed to speak to a gp today (never the same one twice) who would not entertain the possibility that the neck pain was muscular skeletal rather than pmr. His suggestion is to increase to 15mg for 2 weeks, then 10mg for a week and then back to 5mg.

I can see his logic but I wonder if it's sensible to muck about with doses to this extent.

Any views please?

[DorsetLady PMRGCAuk volunteer]

Not sure how GP can say it’s not musculoskeletal, so therefore it’s PMR…..

a. He hasn’t examined you or referred you for further investigation -X-ray, physio etc,

b. As we all know PMR is usually bilateral, not always, but as it’s been going on for a few weeks would expect it t9 be affecting bith sides by now.

As your trial at 10mg didn’t reduce pain, he’s obviously being led by the bloods, assuming just because CRP has reduced in must be PMR…not necessarily, it just shows inflammation has been reduced, but not what’s causing inflammation…

As his suggestion shouldn’t upset things too much, might be wise to try it, then at least you can go back with results….and if pain persists he’ll then have to look elsewhere for cause.

[Jontie in reply to DorsetLady]

I agree. As you say, it should be useful "diagnistically" if nothing else. If pain doesn't go on 15mg, surely it is something other than pmr. Just frustrating I have to increase dose again before gp will investigate other possibilities. Hey, ho!

[DorsetLady PMRGCAuk volunteer in reply to Jontie]

Yes but it’s only 3 weeks

[PMRpro Ambassador]

I'm not sure I can entirely see his logic but it would be the same as a short course of pred for something and returning to baseline and is the same as the original tapering course I had though I was made to stop which wasn't a good idea.

The fact the CRP fell at 10mg does suggest there was inflammation causing the problem - but maybe it wasn't long enough to let the muscle recover fully. Have you tried anything else? Like stretches and heat?

Mind you - does the gentleman not consider PMR itself to be a musculoskeletal problem????

[Jontie]

I've tried heat, which makes it feel better while the heat is there, but the beneficial effect stops shortly after the heat is removed. Good point about pmr being musculoskeletal! Oh well, I'll give it a go. Thanks.