Neck and shoulder pain

[JaiSea]

Good Morning. My journey with Prednisolone, has been a ‘yo-yo’ experience, but eventually reaching zero after two years, although the resulting symptoms suggested that Methotrexate wasn’t the ‘all conquering hero’ of the hour. Good advice and information from fellow members indicated I might be expecting too much in too short a time, and re-establishing a Pred dose could ease my situation. The taking of Pred with the MTX was an option my Rheumy had given me, so without further complications I chose to add 5mg of Pred to my daily meds, but found that it wasn’t curtailing the neck and shoulder pain to a manageable level. I have unilaterally increased the Pred by 1mg steps to 7mg over a month, but advised my Rheumy accordingly, the 7mg has reduced the pain to an acceptable intensity.

Further investigation of the neck and shoulder pain has resulted as a report stating “only shown moderately severe degenerative changes” in my cervical spine, and that it is unlikely to be related to my temporal arteritis. No mention of the PMR. I hadn’t experienced any unrelenting neck and shoulder pain until the present, being relatively fit and active upto the diagnosis of PMRGCA and trying to keep to a reasonable level activity afterwards. If the corticosteroids have reduced the pain, improved my sleep and allowed me further exercise, I concluded there was a relationship between this problem and PMRGCA, but admittedly I do see all the medical disadvantages I have experienced as related, and not coincidental.

Question, do any other members experience this awkward painful condition, and / or the increase of Prednisolone legitimately easing the pain, or simply masking it by working on the underlying PMRGCA and giving me a ‘feel good’ factor?

[PMRpro Ambassador]

PMR can be a part of GCA for a large proportion of patients. Part of PMR can also be myofascial pain syndrome and that can affect neck and shoulders quite severely.

jrheum.org/content/46/12/1552

The probable reason for 5mg not cutting the mustard was that there had, in the meantime, been a build up of inflammation - which must be cleared out before symptom relief is experienced at any dose. I have quite severe myofascial pain syndrome affecting my back and it takes some doing to sort it out once it is established, mere extra pred is never enough but targeted specific treatment options do help a lot. I personally like therapeutic massage but you do tend to feel worse before you feel better as the massage releases the cytokines trapped in the muscle fascia and trigger points so until they are flushed out of the system you feel as if it is a PMR flare but it does fade as the cytokines are got rid of and not replaced by the ongoing PMR effect.

And in 14 years I have never experienced the pred feel-good factor that some doctors are so convinced of. Just gratefulness for the relief of pain it achieves.

[JaiSea in reply to PMRpro]

Thank you for the information and the explanation, it is certainly enlightening. No reading matter I have received from the NHS has that clarity and being a member of this online forum is extremely beneficial.

It does appear that it is a complex juggling situation, for which you have the experience and a level of mastery, whereas I perceive myself as a bewildered beginner. I should, then, reconsider my Pred dose, with my added airborne ‘ball’ of diabetes, and the three fold increase of insulin caused by the re established Pred.

I can agree wholeheartedly that the relief associated with Pred was important, but perhaps that ‘up’ is misinterpreted as ‘feel good’ by the external medical perceptions. I’m but an ‘engineer’, and have been pragmatic about the benefits of Pred for the treatment of my PMRGCA, which besides the pain relief, I felt gave me strength again, allowing me to trek and wild camp through Scandinavia, and that was a great plus!