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
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Chris_1236
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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?
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.
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.
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.
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...
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.
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