Pred "quick" spike for back injury

[Chris_1236]

Due to a level 1 herniated L5-S1 disc, I have an occasional flare up of most painful sciatica. My PCP normally recommends a temporary spike of Pred to the tune of 30-30, 20-20, 15-15, etc. until I'm back at my current daily dose.

You may view my PMR dose taper history in my profile for reference, but this time I seem to have had a PMR flare while going through this six day spike.

My question is: Is a transient spike in Pred a good idea for those with PMR? If so, is there a better plan for spike-and-taper than I've described above? Ie. Should the taper be a bit longer and slower like we "normally" do for just PMR?

Kindest regards,

Chris

[PMRpro Ambassador]

No, it is fine to take a spike like that and shouldn't affect the overall slower taper at all.

However - I would be more interested in why you get repeated flares. Is it possibly because you need a tad more pred on a longer term basis or is it mostly related to an unwary move that upsets your back?

[Chris_1236 in reply to PMRpro]

I think you are on track with the tad more Pred over a longer term advice. Mainly for the reasons I mentioned in my reply to DorsetLady . Doubtless the back issue flaring up does not help either.

It is nice to know that a brief spike shouldn't affect things otherwise though.

Thank you for your help.

[PMRpro Ambassador in reply to Chris_1236]

There is absolutely no point struggling on even 1/2mg too little - the dripping tap effect will take you to the same place as 2mg too low, just take longer to get there!

A targeted steroid shot for bursitis is a VERY different thing from spinal intrathecal injections - I'd be very reticent about having one of them too! But the bursitis injections are NOT into the joint space, my rheumy just pokes at the trochanter area until I shriek loudest and the injection is into soft tissue. Another option for trochanteric pain syndrome is extracorporeal shick wave therapy - similar to the technology used to break down kidney stones but adapted to use on soft tissue. It is non-invasive and afer 3 or 4 treatments extremely effective.

physio-pedia.com/Extracorpo...

Interestingly, I note a pacemaker is a contraindication - I have one and both lots of treatment I have had were fine.

[Chris_1236 in reply to PMRpro]

Unfortunately this disc is pressing on the root of my left sciatic nerve. Pressure and some pain are constant companions, but when it gets upset, worse effects set in.

I hope to avoid surgery, but may not be able to in the end.

[DorsetLady PMRGCAuk volunteer]

Slightly strange way of dealing with sciatica - but if it works, it works - but would have thought a targeted cortisone injection would have been better.

If you had a PMR flare this time, this link contains advice for dealing with same - but would also add that reducing every fortnight [even though its only 0.5mg a time] as you seem to be doing is probably not a good idea... it can take 2 weeks for you to know if current dose is enough before you drop to lower one - do that a few times, and you end up flaring, and also not knowing your last "good" dose was...

healthunlocked.com/pmrgcauk...

[Chris_1236 in reply to DorsetLady]

The mode of treatment is by choice on my part. I watched my wife have a spinal injection of cortisone as a last ditch effort to avoid a cervical fusion and would never ask a person to go through that agony. Just my personal feelings though. I'm sure that sort of treatment works for some. 😊

So I spend time on an inversion table which actually works wonders... As long as I'm consistent. Unfortunately I have to climb stairs several times a day which does not help with either my back or PMR I'm sure.

Regarding my taper, I suspect that you are correct particularly over the last four weeks or so and given that I maintain a pretty active life in spite of PMR. Not as active as before, but probably more than is advisable.

😟

At present I've run back up to 15mg and things are clearing up. I'll stay there for a month and then see how things stand.

Thank you for your valuable insight.