PMR or pain from other causes

[arvine]

I have posted a list of issues in past number of months, re in particular back and hip problems, all seen on MRI,s and some stressful events as well, ie nerve root impingement, spinal stenosis, buldging disc s, degenerative, tears in gluteus and hamstrin, labral, osteo in hips, so many problems, rhuemy advise continue taper, almost down to 5 mgs daily in last few weeks, how would cause from pain be distinguished between all of these issues and PMR ? Mornings are particularly bad for few hrs,

[SnazzyD]

I have no idea. I guess the pains that get worse with reduction are more likely to be PMR? Morning pain could be just pain associated with hours of inactivity; it is a problem to work it out I’m sure.

[arvine in reply to SnazzyD]

Thanks Snazzy, but the isues Ive mentioned are not typical of PMR symptons I dont believe , and have been diagnosed based on MRI reports, that s why I do nt think pain is caused from PMR, and rheumy has said didnt think I actually still havecPMR, and advised continue with taper, and is believed there are no tests to diagnose PMR or if still active after 7 yrs , and still on prednisone

[Downtime]

I was diagnosed with RA 9 years ago and PMR 18months ago.I also have osteoarthritis. After a review with a different consultant the original RA diagnosis is now in doubt and it might have been inflammatory osteoarthritis al along. Anyway I have been told to slowly taper the PMR steroids and I’m now down to 4 mgs. He did say that as I taper I will start to feel all the osteoarthritis pain again and this might be the case for you too because the prednisalone stops osteo inflammation as well as the PMR pain. He said that to have quality of life I might have to stay on a very low dose steroid, 2 or 3 mgs , with NSAIDs to help with this . I’d loved to have stayed on the higher dose steroid but it seems that’s a not an option,

[PMRpro Ambassador in reply to Downtime]

Blowed if I can see why a slightly higher dose of pred ALONE is regarded as less of an option than not quite enough pred and constant NSAIDs! I have chronic low back pain and worked out a way to manage it acceptably for me using ibuprofen - 400-600mg A DAY did a pretty decent job, wasn't perfect but I could live with it. The doctor in the Pain Clinic had a hissy fit at the idea of constant NSAIDs at ANY level because of the emerging long term effects on fenal and cardiac function.

Luckily my rheumatologist was willing to do a procedure the pain clinic wasn't and it has made a massive difference. I knew from previous experience it was the most likely to work but the PC said no. In fact, she mostly said no ... But I keep going as she has her uses!!!

[Downtime in reply to PMRpro]

It seems that both Pred and NSAIDS are no nos as far as GPs are concerned. They expect you to just suffer. Unfortunately paracetamol just doesn’t cut the mustard . My first Rheumy prescribed Methotrexate and 1600 mg Brufen Retard daily fir my RA, which I took for 8 years without any obvious problems. In fact when I had a serious melanoma with a poor prognosis I am still here after 5 years and the dermatologist said NSAIDS can stop the spread so I’m eternally grateful for them, so far so good . 🤞

[PMRpro Ambassador in reply to Downtime]

No, paracetamol is pretty pathetic - though it does seem to have done something last night.

Excellent news on the melanoma front - horrible disease but much better options now.

[arvine in reply to PMRpro]

What procedure was rheumy willing to do that helped you?

[PMRpro Ambassador in reply to arvine]

I've described it several times recently, including to you. An ultrasound guided steroid injection into the sacroiliac joint.

[arvine in reply to PMRpro]

Ah, sorry my mind little cloudy last few mos, thank you

[Pixix]

I have 11 diagnosed medical complaints, & I can no longer tell! But I think back to the main strange symptoms I had when I started PMR, which weren’t linked to others (there were a lot of cross over)…chest pains, shoulder pains, sweats so bad it was like turning a tap on. Those are the ones I don’t truly get all at once from any other issue. I have a flareup right now, all three of those are back. But not as bad as prior to starting pred. My Dr is keeping me on 2mg at the moment. Other parts of the body are bad due to PMR, but they are also bad for other reasons eg hips are bad due to PMR, osteoarthritis & bursitis. My rheumy advised me to taper off steroids by September last year. It’s taken 3 tries to get down to 2mg without going back to five again. Apart from trying to separate out the PMR issues, it doesn’t matter about where the pain & symptoms come from the rest, for me. I would like to get off the steroids completely, I don’t want to increase again.

[arvine in reply to Pixix]

Yes that s the way I feel, 7 yrs plus of pred I believe takes a toll on body

[Pixix in reply to arvine]

I took a lot of short courses for lung issues, years before I got diagnosed with PMR. I was relieved he knew what was wrong with me, but I immediately refused to take more steroids. I’d had a lot of problems & side effects from them before!! But then I found there was no choice…& still hate the devil’s tictacs just as much!

[arvine in reply to Pixix]

Yes, such controversary about steroids, along with all the current( in last year) isues, have had chronic lower back problems for years, now my age is probably reason it s worse, PMRpro, said she has had for years too, and apparently guided ultrasound steroid injection in sacroilliac has been very helpful, my rheumy doesnt do that, but may be seeking that option out soon , with another facility

[PMRpro Ambassador in reply to arvine]

Low back pain can have many underlying causes - before you can expect a particular treatment, you have to diagnose the actual cause to see if it is appropriate. Just because it worked for me doesn't mean it will work for you.

[arvine in reply to PMRpro]

I have listed all results of what caausing lowet back pain most recently to Pixie I believe

[Pixix in reply to arvine]

I have had chronic low back pain for 9 years now. But mine is due to a benign tumour, which is too near to the spinal cord to be operated on. Guided injection wouldn’t help mine at all. I’m surprised you are seeing a rheumy for back pain, but perhaps your back pain is associated with PMR. I concur with PMRPro, many reasons for lower back pain, & you need a diagnosis first & foremost!

[arvine in reply to Pixix]

Oh I started seeing a rheumy in Oct 2016 for PMR, my back problems have been diagnosed as , spinal stenosis, buldging discs, degenerative disease, and in the last year, merve root impingement, from ruptured disc, which I believe happrned after some injection I had by anesthesiologist, and believe one injection of anesthetic hit anerve at the time which put me thru the roof with pain, thus the pain strarted there, L2-3 disc. But I continued with rheumy as still was on pred at the time and still am

[Pixix in reply to arvine]

I think that, if you were in England, you would have seen an orthopaedic surgeon with those problems and/or a neurologist. I think. Then one of those would be the person to suggest a treatment plan to you. Going back to your question about how to distinguish pain from one source or another, perhaps try writing down the symptoms you had when each problem occurred. Then you can refer to that & tell which pain is coming from which problem? It’s the only way I can relate pain to each of my 11 diagnosed items! Take care.

[arvine in reply to Pixix]

Thank you seeing ortopaedic surgeon, consultation this Friday,

[Italybound62]

I have had the exact same question. My regular doctor wants me to wean off steroids. She thinks it will be osteoarthritis pain coming back. But I beleieve the distinguishing symptom is any muscle type pain felt when lifting my arms.

[arvine in reply to Italybound62]

in oct 2016, I got to point couldnt lift arms to brush my teeth or my hair without a lot of stiffness and very painful, that was the most significant sympton and pain, my GP immediately put me on 40 mgs pred , with no bloodwork, and pain subsided within hrs could raise my arms etc, then referred to rheumy within 2 weeks or so had appt, cant rememember bloodwork results but am thinking markers raised then was advised to stary tapering, had few other symptons through the years, shoulder on one side, ultrasound showed calcium build up, evenyually settled after few weeks, pirifirmis syndrone, but initial symptons never returned during the following mos and years, Dec 2022 put back on 40 re pain and tenderness at temple area, been tapering since then slowly due to all other issues since then, that is why dont think my complaints of paim are PMR issues, almost on 5 mgs evety day now for a week

[random901 in reply to arvine]

I, too, am having difficulty distinguishing between pains. The penny dropped in the last few days, though - on top of GCA an PMR, my fibromyalgia has resurfaced, affecting upper arms, intercostal muscles in back and shoulder blade area, hips and buttocks. This was exacerbated by an over-ambitious walk yesterday. A knitting and online jigsaw day today!