Back and rib pain is it PMR?

[KeiraPeg]

Ive been yo yoing with PMR and GCA since 2018, had at least 5 flairs and had to start again from the beginning. Not had any PMR symptoms for last 2 years but GCA is diagnosed by blood results sometimes very high inflammatory markers. Currently taking 8mgs pred.

Problem I have now is very painful back spasms, worse when tired. Between waist and lower shoulder blade. started occasional mild spasm that could be ignored but has got much worse (probably over 2 weeks) now when very bad the spasm goes around the ribs to the front and takes several seconds for me to recover (seems like minutes). Rest does help and when no spasm no pain at all, any sort of exercise will bring it on eventually.

Paracetamol no help.

The only thing I can think of is that I had Covid in June and coughed so bad I hurt my back, the back pain never completely went away but wasn’t like this.

Any ideas anyone,

[SnazzyD]

Small musculoskeletal problems, if left, can turn into bigger ones, especially in the back that gets no rest. If I’ve ever tweaked something, I find there’s only so much Paracetamol can do. Given that you know you had an issue from coughing that never really resolved, I’d go down that route, especially as it is spasmodic. Where does the pain run from and to exactly?

Have you ever had anyone qualified have a prod, not just the back but front as well?

When you say you have GCA flares diagnosed by inflammatory markers, do you mean those alone or in conjunction with symptoms?

[KeiraPeg in reply to SnazzyD]

Thanks for your reply Snazzy. The spasm runs along the base of the ribs at the back mostly, occasionally it feels like a big squeeze right around.

I’ve not seen anyone about it, wasn’t sure who to see, and its only got really bad in the last few days, I thought it would just go away. 🙄

I have some mild symptoms of GCA occasional headache and jaw claudication, also seen in the eye clinic when first diagnosed who agreed with diagnosis. Had a biopsy after taking high dose of pred for 4 four weeks, negative and pet scan this year when still on 7mg Pred again negative.

[PMRpro Ambassador]

Sounds like me - that was one of the areas I developed awful muscle spasms. I have a few things going on including a scoliosis that puts strain on my back muscles and quite innocent things will suddenly put them entirely out of kilter and they protest.

But after my experience last year and tangocharlie 's tale of woe with back pain that turned out to be spinal fractures - I would ask for an x-ray. Despite good dexascan results, this time last year I was found to have a spinal compression fracture - and spinal fractures are the most common cause of back muscle spasms. Now whether mine was entirely that is difficult to say, I had had back problems long before the fracture was found. All I know is that after the first of a course of bisphosphonate infusions, the back pain has slowly improved to a state now of being negligible. It may be coincidence - but it is worth ruling out. Sharp stabbing pains of the sort you describe could be a spasmed muscle pinching the nerve that runs around that level above the waist and had also been a much earlier problem for me.

[PMRnewbie2017]

Have you heard of Myofascial Pain Syndrome? It does affect people with PMR and can be extremely painful. When I get it, it lurks between my right shoulder blade and my spine. Sometimes the muscles between my ribs are affected too and it's really painful to take a deep breath in. I can only describe the pain as being like toothache in a muscle and it does come in waves or spasms. I read somewhere that MPS is caused by IL-6 build up in the myofascial layer which covers muscles. This seems to make sense to me as PMR is said to be due to over production of the cytokine IL-6. I take Ibuprofen at a high dose for one dose (600mg) and that shifts it, if I catch it early enough. Paracetamol doesn't help, probably because it is analgesic not anti-inflammatory in its mode of action. The only other way to get relief is to have the "knots" massaged out by a therapist.

[PMRpro Ambassador in reply to PMRnewbie2017]

Some think it's cause is a defining part of the PMR pathology

jrheum.org/content/46/12/1552

Claire Owen has done some super stuff with regard to PMR

[Stills in reply to PMRnewbie2017]

This is interesting to me, I have diabolical flank pain , which I think is side of ribs starting mid back moving ti high side front …. Made worse with any activity. I attribute it to my rheumatoid condition but it’s getting worse so I’ll read up on MPS thank you and merry Christmas

[KeiraPeg]

Thank you that’s a lot to take in, never heard of Myofascial pain syndrome. Will read and try to understand. Saw Gp yesterday, was sympathetic but its Christmas so go home and rest if it’s still bad after Christmas she will organise an X-ray or MRI.

Happy Christmas everyone.

[PMRpro Ambassador in reply to KeiraPeg]

"never heard of Myofascial pain syndrome"

Unfortunately - neither have a lot of doctors!! But it and PMR can make an unholy duo!!! Keep the MPS in check and you can get away with less pred for the PMR.