Pmr or just a sore back?

[ponai]

Been at this for 7 years, a few on 3mg pred, up to 6 last October after my covid vaccine as I was climbing stairs on hands and knees. Started reducing again this summer, slowly, and was definitely feeling better at 4 1/2, when a few weeks ago I put my back out. No event, but really painful with spasms, mostly right side, and upped to 6 again which maybe helped a bit. It's still a problem, especially at 4am. Both heat and time help, possibly the paracetamol. I'm not sure that the pred makes a difference, and am tempted to slowly reduce again.

Is it possible that the back is not related to the pred reduction? I don't have more pmr-type pain. I've tried 5 1/2 for a few days and it doesn't seem worse or better. I don't know whether to treat it as a pmr flare or just an unrelated extra. I know, another unanswerable question, but would appreciate advice or sympathy...

[DorsetLady PMRGCAuk volunteer]

Sounds more like an unrelated extra - if increased Pred [although 1.5mg is not a great increase] doesn’t make that much difference… but the 4am issue may be tweaking the PMR a little. So to that end, I wouldn’t be in too much of a hurry to drop back…and keep up with the heat and paracetamol …

As a fellow creaky back person you certainly have my sympathy…. 😊

[PMRpro Ambassador]

You can have sympathy - I have the same problem! It is sacroiliitis and muscle spasms for me. It is a myofascial pain/greater trochanteric pain syndrome manifestation. Unfortunately I can't have the ideal treatments (for me at least) of steroid injections as I am on anticoagulant medication and there is a risk of bleeding. Nor can I use NSAIDs as much as would be ideal (that works well!), paracetamol does next to nothing.

I believe extracorporeal shock wave therapy is supposed to help. I have had it for trochanteric bursitis and it did work well for about a year.

I have just been travelling on a very hectic schedule and decided to up my pred for the week from 6 to 10mg. The pain is not entirely away but it is almost gone except early mornings - there may have to be a discussion with my rheumy in January!

[ponai]

Thanks for the sympathy. I tend to think pmr and pred cause everything, but then there's age, weather, general activity- this is a very complicated condition to manage, and it's good to find people on this forum who understand. But isn't it difficult!