Is it ok to take painkillers with Prednisolone?

[Preposterous]

I have recently had probable PMR diagnosis and am on day 2 of week’s trial on 15mg prednisolone. Too early to see if it’s having effect but had partially sleepless 1st night and PMR symptoms worse than ever this morning plus slight headache (but that could be lack of sleep). Before GP confirmed my suspicions that my muscle pains were PMR I was relying on ibuprofen, usually + codeine, to enable me to function which kicked in after a couple of hours. My question is - is it ok to take ibuprofen alongside the steroid pills? If not what painkiller can safely be combined? I will try and call GP but suspect I won’t be able to ask the question without making another phone appointment - ie not a quick answer.

[SnazzyD]

No you shouldn’t take Ibuprofen (or any non-steroidal anti inflammatories) with Pred but Paracetamol or codeine is fine. These kind of questions are best put to a pharmacist, plus they are more accessible! Regards the pain, remember you do need to take time off, stop any pushing through and slow down, you are properly ill. You might say, “chance would a fine thing!”. However, if Pred does work on your symptoms, you might be tempted to go for it.

[Preposterous in reply to SnazzyD]

Thank you very much - that’s very helpful!

[PMRpro Ambassador]

IF you need ibuprofen, then you need stomach protection in the form of a PPI or H2 antagonist. 15mg is the bottom end of the starting dose range and it is possible you may need a bit more but it is also very early days with pred. Paracetamol and codeine combinations are OK with pred - but for me paracetamol does nothing and I can't take codeine.

You say that you were managing your symptoms with ibuprofen and codeine before diagnosis - and for us that rings alarm bells: PMR very very rarely responds to ordinary painkillers. The worsening of the symptoms and headache need keeping an eye on - if that continues you need an EMERGENCY appointment with a GP just in case this could be GCA rumbling in the background.

[Preposterous in reply to PMRpro]

Yes, GP prescribed stomach protection pills (Lansoprazole I think), which I started taking on same day as Prednisolone.

I'm puzzled about Ibuprofen - it definitely seemed to make a huge difference a few weeks ago, unless the PMR was lessening a couple of hours after I got up of its own accord.

[PMRpro Ambassador in reply to Preposterous]

In the early stages it may well have - once you are up and moving and blood flow to the muscles improves, you can feel a lot better.

If you end up with gut problems, don't assume it is the pred. The PPIs can cause some unpleasant effects which no-one ever associates with them as they are supposed to PROTECT the stomach!!

[DorsetLady PMRGCAuk volunteer]

For many 2days is too soon to know but you need to stick with it.. and as said no to ibuprofen is usual advice.

Is paracetamol enough for headache -if sleep associated?

[Preposterous in reply to DorsetLady]

Thank you for advice. Paracetamol has helped headache I think though maybe it would’ve gone anyway. I know I must be patient with this- it came on quite out of the blue in January with sore back at first but then seemed to creep all over. I’ve never had problems like this before and have generally been fairly fit/active. I guess it’s knocked me sideways somewhat. I’m so glad a friend recommended this forum!

[DorsetLady PMRGCAuk volunteer in reply to Preposterous]

It very often does come on out of the blue, it does knock you sideways -and well done your friend😳

Maybe have a read of this -not too scary I hope -

healthunlocked.com/pmrgcauk...

[Preposterous in reply to DorsetLady]

Thank you for sending the link, which I've read through quite quickly but will go back to and digest thoroughly.

[DorsetLady PMRGCAuk volunteer in reply to Preposterous]

Do hang on to it - if you do have PMR it will make a lot more sense to you in a few months….

[waltztherapy in reply to DorsetLady]

Thanks for the excellent link DL, a full and helpful read. I shall keep it as my reference. X

[piglette]

what happened when you took Ibuprofen? Did they work? PMR usually is not really helped by painkillers, it is just steroids that seem to help the pain. Normally the result is quite magical.

[Preposterous in reply to piglette]

At first Ibuprofen worked wonders - I took a 400mg pill with breakfast, and within a couple of hours I found my mobility was largely restored and I could function fine, even fairly strenuous gardening! But after a couple of weeks ibuprofen stopped being so effective. I tried Ibuprofen & Codeine, at first okay but again became less effective. This was while I was trying to get a GP appointment - initially I was referred to what turned out to be the practice's physiotherapist, which to be honest wasted time although he was a perfectly good physio. I self-diagnosed via the NHS website as a result of which he recommended I ask for a GP.

[PMRpro Ambassador in reply to Preposterous]

Often it is a physio who suspects what the diagnosis is. They aren't very good at helping it though!!

[piglette in reply to Preposterous]

I suppose there are two posdibilities, you need a higher dose of steroids or it is not PMR. You could try a painkiller for a short time to see if it works. You could then try a higher dose of steroids say 20mg if the painkiller does not work. Steroids can take a few days to work, although I had relief in less than twenty four hours.

[Lickle in reply to Preposterous]

Your start sounds very similar to my own from just before Xmas '23. I took Ibuprofen at first and felt it helped me through the days with 3 a day and especially just before bedtime helped me sleep without pain. After a GP sent me for a more detailed blood test I got the diagnosis of PMR and was immediately put on 15 mg per day of Pred, along with Omniprazole first thing in the morning to stop any bowel trouble. It only took about 3 days for the Pred to ease the pains, and over 2 weeks to completely notice the lack of symptoms. Occasionally, you can feel some smaller pains fighting back, like toes, scalp stiffness, but stick with the pred only.

I also put myself on a no carb diet which meant I lost 20+ pounds over a month, the consequences of that meant that I could get back in the gym and do just cardio/stamina training, 3 times a week. I'm now tapering down at 12.5mg and noted that the Pred doesn't like the resistance of weight training so have stuck with the cardio work. Although I still think I get the odd twinge of PMR, I can't be sure that is what it is but I am feeling fantastic now.

I was also put on metformin at the time for just creeping into type 2 diabetes but my blood tests are no what my GP calls, "reassuring!" He does not want me to reduce the metformin though because the pred apparently increases the blood sugar. I am, however, reducing the metformin on my own back. Had a blood test yesterday so will see what the GP says when we go through the results next week.

Meantime, I'll increase my gym work on the cardio machines, treadmill, bike & rower, interspersed with Planks/wall sits/push ups as per Michael Mosley's recommendations on tv. I also added 3/4 cups of green tea per day and within 1 week of that it took 10 points off the top of my blood pressure readings.

Hoping to taper down to 10mg of pred after my next GP discussion on the latest blood test results next week.

[DorsetLady PMRGCAuk volunteer in reply to Lickle]

Pred affected muscles don’t like weight training or anything very repetitive -they need more time to recover.

And if/when you increase all exercise, it’s needs to be done gently. You might feel fantastic, but just be aware Pred can make you feel like that -but you still have the underlying disease.

Tapers need to be based on how you feel in yourself (so no symptoms) not just on blood results…

Sounds as if you are doing well so far, so fingers crossed it remains that way..

[Lickle in reply to DorsetLady]

Thanks, yes I realise that pred can mask pain. I am generally watchful of any twinges, but it is so difficult to know what is normal & not. When PMR first materialised, and in early days of Pred, I thought it was gout as while driving it felt like there was a rat nibbling at my toes, and at other times as if the back of my neck or scalp tingled.

I felt originally that the PMR was the kick start I needed to lose weight and get fitter. That is what has happened, so as you say, fingers crossed.

[DorsetLady PMRGCAuk volunteer in reply to Lickle]

Yes Pred can mask pain, but early days when doses are still higher than you will need on a day to day basis once the accumulated inflammation pre drugs has been cleared out - it can give a false energy... and once that goes, reality sets in.. 😏

[Preposterous in reply to Lickle]

What useful advice your reply contains! This forum is proving so helpful. Thank you.

[Lickle in reply to Preposterous]

Since having this PMR, which I'd never heard of before, I've since met others in passing conversation who've had it. My neighbour had it when he was 80 and was off the Pred in 6 months & is now a sprightly 95. Yet another, some 5years younger than I took 7 years to get off. So I'm fully aware that it is a lottery, but felt that if I did the lifestyle change completely, I'd have a better chance of beating it.

I'm lucky in that my new GP seems very experienced in treatment of the condition and has printed off a reduction plan for me.

[DorsetLady PMRGCAuk volunteer in reply to Lickle]

I'm lucky in that my new GP seems very experienced in treatment of the condition and has printed off a reduction plan for me.

But you both need to remember that's all it is - a plan. Life very often throws in a curve ball, and the plan has to be amended..

[Lickle in reply to DorsetLady]

That's where this forum scores in making us aware of all the possibilities, pitfalls etc.

[DorsetLady PMRGCAuk volunteer in reply to Lickle]

‘Cos we’ve been there and no matter how good your doctor is and there are some very knowledgeable ones, they haven’t had GCA or PMR nearly all too young!

The good ones listen to their patients and take things onboard -the others don’t ! 😳

[Lickle in reply to DorsetLady]

Nothing beats experience in life, something I learned to listen to many years back. It's a pity that seems to have become pooh poohed by younger managers etc. nowadays.

[DorsetLady PMRGCAuk volunteer in reply to Lickle]

Yes well, that’s the arrogance of yoof! But one day they may realise the relevance of it… 😉

[random901]

Hi Preposterous! Paracetamol can take the edge off pain but only codeine really works for me, and I'm very sparing with these as they're addictive and could become ineffective. At least I can function on them, though.

[Preposterous in reply to random901]

Do you find codeine starts to have a pain relieving effect quite quickly? So far I’ve not found a painkiller that kicks in for at least a couple of hours. So it’s this tedious non functional wait that makes the day so slow to start. Perhaps I should take something 2 hours before my breakfast + steroid tablets? I suppose it’s all about learning to construct a workable regime!

[DorsetLady PMRGCAuk volunteer in reply to Preposterous]

As you are on 15mg for a 2 week trial, then you shouldn't really be adding in any other painkillers.. or the trial won't give a true reflection of how much or how little the Pred is helping. Sort of defeats the object... 😏

[Preposterous in reply to DorsetLady]

Excellent advice! I can see the sense of that completely. Thank you

[DorsetLady PMRGCAuk volunteer in reply to Preposterous]

If might mean a week or so in more pain than you’d like -but it’s the only way to get the true picture.

[random901 in reply to Preposterous]

Yes I do, Preposterous. The info says it can take up to an hour to work, but it kicks in after 30 minutes with me. Causes mild constipation, but that's easily dealt with. I only take one tablet a day, 2 when fibromyalgia is very painful and I have to do something like walking to catch bus for doctor/ hospital appointment.

[PMRpro Ambassador in reply to Preposterous]

We have in the past suggested taking the pred tablets early doors and settling down for another couple of hours in the warm by which time it should be starting to work. The inflammatory substances are shed in the body about 4-4.30am, the longer you leave it after that, the more inflammation has been created and the more there is to do for the pred.

[Preposterous in reply to PMRpro]

Would you recommend a regime that might help? I.e is it best to start taking the pred at 6am say?

[PMRpro Ambassador in reply to Preposterous]

It is something you have to try and find what works for you - can you get back to sleep after? How long does it take to be able to move?

[Grey7]

If not reacting to steroids could it be Fibromyalgia ?

[random901 in reply to Grey7]

Aha! Yes, it's my fibro which I take the dihydrocodeine for. Flared up on top of my GCA PMR 4 weeks' ago.

[Grey7 in reply to random901]

This has happened to my sister, she tapered off steroids about 4 months ago, i said it was a flare but the doctor told her it was fibromyalgia, perhaps she has both? Her pain levels weren’t raised.

[random901 in reply to Grey7]

I've had FM for 14 years. It flares from time to time. For me, more painful than the other conditions, and tends to be widespread and random. Knitting difficult today.

[Floridafan]

Have you had a blood test to test your inflammation markers (CRP & ESR)? This would help with the diagnosis of PMR although not everyone has raised levels but they can still have PMR.

[Preposterous in reply to Floridafan]

Yes, think I’ve had all the relevant blood tests - CRP was moderately high (36 or so) and ESR normal range but on borderline high. Consultation with GP after week’s trial with Pred so will try and find out more then. This online forum has been very helpful!

[cranberryt]

As others have said PMR isn’t helped by anything but steroids. The fact that you had some relief from the other painkillers along with being on day 2 of prednisone without any relief may mean it’s not PMR. Now, some people do take longer to experience relief from the prednisone but most experience dramatic relief (70% or more) within a couple days. I felt blessed relief within 4 hours and 80% within 24 hours. Definitely see the week out, but if it’s PMR, you should have significant relief by then. Some require a higher dose than 15mg, and maybe you are one of those people. Do you have enough to try a higher dose?

[Raven1955]

Might not be the info you're looking for, but I at times have to take hydrocodone to deal with the pain from a couple of worn out knees. Both the GP and pharmacist said it wasn't an issue taking it with prednisone. I do take ibuprofen at times when the knee pain isn't bad enough to justify taking the narcotic. I just am sure to never take it on an empty stomach and have had no issues over my almost 8 years on prednisone. Truthfully it doesn't matter much now, as I'm on a minimal dose of pred now. Today I have to be working at a trade show and will be on my feet on the concrete floors for 10 hours. I take the ibuprofen before I start and it gets my knees through. During my worst times with PMR I would have never even considered doing it. As others have said, ibuprofen shouldn't be having any effect on your PMR. It never helped mine but I am able to take it and other pain relievers for when there are bad times with the knees.