Flare

[Potemkin]

Just over 5 weeks ago I leant over and pulled something in the side of my back, it was only a small twinge. At the time I was on a steady 7mg of Pred. I thought it would take a few days to feel better but it dragged on. I treated it as a pulled muscle and carried on with a slight improvement and did not feel the need to take painkillers.

A couple of weeks ago I decided to taper even though my back wasn't fully better - obviously a mistake. I went down to 6mg which was probably too much.

At the weekend I started to feel quite bad with my lower back feeling like it was seizing up - I was in a lot of pain so I upped my Pred to 10mg on Sunday. I've also been feeling much more fatigued. I think I should now treat this as a flare.

My question is - should I up to more as the pain is at about 70% or stick at 10mg? How long should I stick at it for? Then my assumption is to go back to 7mg and stay there for a while to stabilise before starting to taper again.

My last question is - if you pull a muscle does it take longer to heal than pre PMR? If it happens again, would it be advisable to increase the Pred immediately or soon after, say after 2-3 days. Do I need to let my Dr know I am having a flare?

Thank you

[piglette]

If you increase by 5mg for a week or so you will be sure that you have hit the PMR on the head you can then reduce to say 7mg and see if that is OK.

[Potemkin in reply to piglette]

Thank you!

[SnazzyD]

When you say side of the back, do you mean ribs? You felt something go at the time which suggests an injury. Small musculoskeletal trauma can become a bigger issue depending on how the surrounding tissues are made to compensate. If left, sometimes it gets better and others it just sets up a wider, chronic situation that needs targeted intervention like physio, osteopathy, topical treatment, avoidance of abusive forces or muscle relaxant medication.

Pred may not be a cure for it, though I would imagine a reduction in Pred would make it feel worse amongst the general withdrawal effect. I found when I reduced, it highlighted all my everyday niggles and tweaks from the past. Pred and the deconditioning that goes with PMR/GCA will make injuries more likely can can make the healing process longer.

[Potemkin in reply to SnazzyD]

Hi - no, much lower, at the bottom of my back but on the side. I leant over with a hand held vacuum cleaner that I was handed and decided to get a bit of cat litter up. Instant pain - like a twinge. It hurt for a while but I didn't need painkillers. It then just seemed to get worse and has lasted much longer than any similar injury pre pred.

[SnazzyD in reply to Potemkin]

That’s the trouble. If you can it might be worth seeing someone who deals with MSK issues to diagnose what you’ve done to yourself. It’s always that last little reach or bit isn’t it?

[Potemkin in reply to SnazzyD]

Yes - I need to work on my core! Good advice - I'll see how I go for this week but may make an appointment next week as a precaution.

[PMRpro Ambassador]

We usually say add 5mg to where the flare happened - so you would have gone to 12mg. That 2mg can make a big difference.

It is likely to take longer to recover than pre-PMR and pred. But what you are describing is a fairly common low hack problem - you tug on a muscle and hurt it and a bit later you do something else and your back goes into spasm to try to protect itself from further damage.

We'd usually say don't reduce your dose if you have any muscular pain - but also that increasing pred for an injury won't really help. I find a flooding dose of 800mg ibuprofen and sitting with heat over the sore bit makes a big difference. But if it doesn't settle, a physio may be able to help. The UK tends to be very dismissive of low back pain.

[Lyndaki in reply to PMRpro]

Sorry to jump in on this but I just want to ask about ibuprofen. Is that 800mg a one-off dose? And I know we’re not supposed to regularly take ibuprofen with Prednisolone but I’m still suffering with back pain after my fall, despite weekly physio sessions which are gradually helping, so I wondered if I could try taking it? What is the recommendation please? Thanks.

[PMRpro Ambassador in reply to Lyndaki]

Yes - ibuprofen was designed to be used like that, you have to flood all the receptors it attaches too and then it works much better, The company were furious when the OTC approval insisted it has to be the small doses. If you find ibuprofen doesn't work for you - that is why! The odd dose taken like that with food should be OK but you can always take a few days of a PPI if you need more ibuprofen - my rheumy uses courses of NSAIDs for some things but insists on a PPI being taken as well as long as you are on them. It's the only time I take a PPI.

[Lyndaki in reply to PMRpro]

Many thanks! Will give it a go!

[Potemkin]

Thanks - I am using heat but allergic to ibuprofen unfortunately. I will now up to 12mg until the weekend.

[PMRpro Ambassador in reply to Potemkin]

Shame. It does need some degree of antiinflammatory but somehow pred isn't the right sort.