Flare or not?

[Topsy57]

Ive tapered down to 5mg four weeks ago, the last day or two I have had shooting pains in right side of head, do I upt my prednisolone and how long for? I have taken paracetamols but the pain comes back after five hours. Its like neuralgia. Just worried the PMR/GCA is coming back. TIA

[DorsetLady PMRGCAuk volunteer]

If you you think it a flare [and it could be after a month] then follow the advice in this link -But honestly I wouldn’t expect paracetamol to last much longer than 5 hours for any pain, and as it is only one sided, I might be keeping an open mind. Have you done anything to your neck or shoulder that side ?

healthunlocked.com/pmrgcauk...

[Topsy57 in reply to DorsetLady]

Thats a big help, many thanks.

[PMRpro Ambassador]

Like DL I think it could be something else too and even if you do treat it as a flare, you need advice from your medical team as soon as possible.

Sternocleidomastoid muscle tightness can also cause that sort of pain and that can be due to a wrenched neck or even being in a draught. Or temporomandibular joint problems.

[Topsy57 in reply to PMRpro]

Thank you for your reply, it is like a neuralgia pain, maybe it is a draft.

[Wizardgood]

This has happened to me in the past and I am always loathe to increase prednisolone. What has worked for me is paracetamol. If it is GCA paracetamol will have no effect whatsoever. I have found this to be a good safeguard. Hope this helps.

[Topsy57 in reply to Wizardgood]

Thank you. It goes for five or six hours with paracetamol then comes back, having said that I've not had the shooting pains today, yay! Now the quandary should I go from 5mg to 4mg after a month on 5mg. There's always something to worry about.

[PMRpro Ambassador in reply to Topsy57]

Paracetamol is doing well to last 6 hours. If you dose for a few days so the pain doesn't return, you might find it has gone

[Plateman]

I'm in my 4th year of polymyalgia, from which Prenisalone saves my bacon. Starting at 20 mgpd, I declined a year ago to 5mgpd, than to 4, then 3, BUT now it re-appeared and wouldn't accept a quick return to 5. Doctors these days being tied up with other things than advising/seeing sick people, I self-prescribed 10mgpd for a few days, it worked, and then I progressively slipped back to the 5 safe house.

I conclude that that is going to be the permanent dose until my maker calls and lets me leave my aches at the pearly gates. Try it, Topsy - it's not the end of the world. Yet.

[PMRpro Ambassador in reply to Plateman]

I don't think that is necessarily the case. For the vast majority of patients it DOES burn out altogether and they get off pred - but that often takes 5 years or more. One study found it takes more than 6 years for half of patients to get off pred - part of that is the time it takes for adrenal function to return satisfactorily and obviously, the longer you have been on pred, the longer that is likely to take.