PMR and/or periformus?

[ponai]

I have one sided buttock pain that makes walking/sleeping difficult- the same thing happened last year at this time but receded after some months. I'm on 5mg pred, after 8 years, have some niggles, and it's a struggle to have enough energy to get through them. Paracetamol and voltarol help a bit, but only marginally. I assume it's connected to PMR as the muscles are the problem, but am I right in assuming more Pred wouldn't help? I'm reluctant to risk adrenal problems at this level unless it might. (I did climb too many stairs a few weeks ago on holiday.)

[PMRpro Ambassador]

Piriformis syndrome can be part of PMR but can also exist in its own right. Stretches do help so have a look at these:

myhealth.alberta.ca/Health/....

Increasing oral pred rarely helps unless it is because the PMR as a whole is not being well managed. The buttock pain is one thing where I find a one-off 800mg ibuprofen and a hot water bottle carefully positioned achieve a good effect!

[ponai in reply to PMRpro]

Thanks.. yes, heat is wonderful. Will try exercises.

[PMRpro Ambassador in reply to ponai]

Our local rehab specialist is insistent that whatever other therapies may be used, ongoing exercises for trochanteric bursitis and piriformis problems are key.

[SnazzyD in reply to ponai]

I find daily maintenance stretches for the buttock and pelvic muscles are essential to prevent pain and dysfunction. It isn’t PMR and paracetamol makes no difference if I lapse for too long.

[Polygolfer]

Dear Ponai, have you discussed with your doctor or with a physio?? Ibuprofen should relieve acure periformis but some simple stretches will help too! All available on Google if you can access that or your run of the mill GP can advise or refer to a physio

[Polygolfer]

best is to speak to your doctor as if your stomach is sensitive to steroids it’s not advisable to mix with Ibuprofen!

[Zebedee44]

Hi, I am in the same boat and trying to manage a very painful right hip and leg pain which stems from my buttock. It seemed to be sciatica when it started in January so I did the appropriate stretches and strengthening I found on YouTube. I did them every day and continued walking my dogs in great pain but after three months I began to think they weren’t helping.

I was referred to MSK Triage who sent me to a physiotherapist who finally, nine months later, identified gluteal tendinopathy requiring a different set of exercises. I do feel that failure to correctly identify the problem has exacerbated the problem. Masking the pain with powerful pain relief has been the proposed treatment but I have refused that option and have asked for a review, including imaging.

I am also eight years into PMR and trying to maintain a good QOL at 3.5 mg with paracetomol and the occasional Co-codamol. My GP tells me more pred would not relieve neurological pain which is good because I have no wish to increase after such a long struggle to reduce and trying to manage the adrenals. I really empathise with you.

[ponai in reply to Zebedee44]

Yes, correctly identifying the problem is the main issue! PMR is so complicated it muddies the water. Thanks for the empathy, and good luck.

[Orpheus82]

I had a very similar situation 6 months ago. Pain was so intense I could hardly walk. Strong painkillers and physio helped but an x-ray ordered by my GP revealed a fracture of T12. Although my DEXA scan showed no change from 3 years previously and I remain mildly osteopenic I agreed to an infusion of Zolendronic acid. Best to keep an open mind and discuss with your GP. Hope you feel better soon.

[PMRpro Ambassador in reply to Orpheus82]

Exactly the same as me - has your pain improved since the infusion? Mine has steadily faded and really all that is left is the pain from something else. But this time last year I bought a rollator because walking was so difficult and I couldn't see any other way out. I haven't actually used it in fact but it is there.

[Orpheus82 in reply to PMRpro]

The pain has improved and I just have the odd piriformis twinge which pre dates developing PMR and usually responds to some stretches.

[PMRCanada]

I’ve had the same symptoms on and off for about 5 years now. Took awhile to isolate and rule out sciatica. The stretches help, but when it’s fully flaring it’s difficult to do them, so I take I ibuprofen and apply warm seed bag over buttock.

Hope you get some relief soon!

[ponai]

And now I've tripped and fallen on a hard floor and have a new kind of pain to add in! Thanks, everybody- I will try everything.

[PMRpro Ambassador in reply to ponai]

Have you been properly checked out after the fall? Nothing broken?

[DorsetLady PMRGCAuk volunteer in reply to ponai]

Maybe invest in a walking stick as well… gives a bit more stablility. Plus as PMRpro has asked, have you been checked over.

[ponai in reply to DorsetLady]

No, nothing broken, and I do usually use a stick... but I was carrying a watering can! Thanks for responses, improving now. I'm getting better at recognizing kinds of pain. And patience...

[DorsetLady PMRGCAuk volunteer in reply to ponai]

Those watering cans can be lethal! 😏