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Need advice re pain relief

Hi, I am curious to know if anyone else has "bad days" in between "good days". I am 47 and still work full-time. I find that when I have been very busy at work, the next day I have a lot of pain in either my neck and shoulders or my buttocks. I work 12.5hr shifts as a nurse so am on my feet all day, the bonus is I have 4 days off a week to rest. Does anyone else have days like this and what painkillers do you take? I find Paracetamol does not touch the pain, but Co-Codamol makes me too sleepy to work. Yesterday I had a lovely massage, and this morning awoke with neck seized up, yet today is my day for reducing Prednisolone from 10mgs to 9mgs. I really need advice to get on top of this in order to continue managing at work. Don't get me wrong a lot of days the steroids do a brilliant job and I have very little pain. Thanks

18 Replies

Yes , I do too!

I find it difficult to pace myself as on a good day I tend to rush around doing everything (as I have loads of energy)

-and then wham, the next day is a bad one!

I haven't found a good painkiller either

Perhaps as you are a Nurse you could visit occupational health to get some advice from them?

Take Care,



Hi runrig01,

You are star for working long shifts with PMR, but you must realise that you are pushing it - you are bound to get more pain if you push yourself physically. I would say that if you are still having pain then the last thing you should do is drop the dose of pred. Working as hard as you do will mean that you will need more pred than if you were not working because putting this illness back to sleep requires much pacing of oneself and an adequate dose of steroids.

I have found that the only drug that I can use to help with reducing doses is Ibuprofen. This has been OKed by my rheumy, but it is not generally recommended. I find that paracetamol makes me feel as if I have been poisoned and likewise for Co-codamol.

Is it not possible for you to alter your shift patterns to have more rest days between shifts?



I'm also a nurse and work long days which usually leaves me shattered and in pain for my days off. I take tramadol for pain which helps. I was diagnosed at 47 which is 3 years ago and haven't improved much and still struggling with steroids. Still hoping for a light at end of the tunnell though!


Hi everyone

i also take tramadol for the pain i ttry not to take to many , i have been unable to work since last july due to pain and mobility



Hi everyone,

Thanks for the replies. My ward manager is very supportive of my pains and would be willing to make changes to my shifts to break my days up. She has also asked if I would rather do 5 x 7.5hr shifts, but the idea of 5 mornings does not appeal as it is mornings when I am worst. I have seen Occupational Health and they have requested I avoid nights whilst taking Amitriptyline at night time, but they do not offer advice on particular analgesics, preferring to leave that to GPs. My GP offered me Tramadol a while back but I declined as I felt it would make me too sleepy to do my shift. Do those of you who take Tramadol find it makes you as sleepy as Co-Codamol?. Perhaps I should speak to GP and see if would consider Brufen for occasional use, or if not try the Tramadol. It is only about 1 day a week that the pains are really bad and I feel I need something else. Thanks again to everyone.


I was a Staff nurse for many years i am now 78 and had PMR AND GCA for last year ,and each time i reduce predislone i have a few bad days till body accepts it ,pain in shoulders ,and so tried i now try to accept it and rest.I Try not to take pain killers as on other medication .

I take my hat off to you working and coping ,good luck in future PMR may go as fast as it came .good luck .


I am so in awe of you people who have to work whilst suffering from PMR with all its pain and stiffness. I do know of a couple of people who were fighting losing battles with work and trying to get their inflammation under control and they both had to take an extended period of sick leave to feel better.

I tried Tramadol during my first year of non-diagnosis but just one pill almost knocked me out. I then tried Ibuprofen and Paracetamol. The Ibuprofen helped in getting me moving for my rheumy appointments, albeit by ambulance and wheelchair, but Paracetamol had no effect whatsoever.

Be very careful with Ibuprofen though - although I only took a small dose twice a day for a few months, I was diagnosed with Chronic Kidney Disease a few months later (I hasten to add I have had just one kidney since a teenager, so I may just have been more susceptible). I would certainly never have considered taking it alongside the steroids, once diagnosed.


The pains I am getting are not associated with the steroid withdrawal. They always follow a busy day where I have overdone it. On days off it is easy to pace myself, the days on the ward I have no control over how manic they can be, although I have a very supportive team. Have just discovered I cannot take Tramadol whilst taking Amitriptyline, so that is out anyway. It really is just about 3 days of the month, where i can be reduced to tears on duty with the pain, that I need extra help, otherwise I am managing without pain relief. My neck suffers the worst, but when I first had the symptoms of PMR the spasms pulled my neck straight resulting in me having a slipped disc in my neck, This is the first area to play up and it goes into a severe spasm presumably to protect the disc. I have high work ethics and do not wish to take time off sick, would rather find something to see me through the day. Thanks to everyone for their useful advice, this has been a god send finding this forum, as to the wealth of knowledge you all are able to offer. Far better than any website information.


Hello I have just discovered this site and have been reading your messages with interest. I hope you are feeling better and not overdoing it. I have just been diagnosed and on day 3 of steroids and a bit better. I also have had neck and back pain as well as facial pain for a while. I have a slipped disc in my back anyway so did not put it together. I am planning massage next week and maybe a walk. Your work sounds heavy going. I am a hospitality lecturer not too hard going but stressful.


Welcome or01ah,

I have only recently found this group as well. Thanks to the wonderful folk on this site, I have received lots of support and useful advice. My work is very demanding I am responsible for the day to day running of the ward as well as looking after a number of patients. I love it truly, but sometimes it feels like a factory production line, as patients are admitted and discharged very fast - thanks to government targets. I am starting to realise I need to take some time to myself during my shifts, to reduce the chance of a bad day the next day.

When you get your massage, ask them to go gently on the areas where you get trouble, I didn't and had a very stiff painful neck the next day. Although in fairness the therapist did say that she had another client with PMR who she had to go gentle with, I foolishly felt I could handle more :-)

Hope your pain settles down now, you usually get a very quick response from the Steroids. I have another 2 slipped discs in my lower spine that are not related to the PMR, so yours may not be related. What it is to get old :-). Take care hope you feel better soon. I am on a period of 7 days off and ensuring I have plenty of relaxation. :-)


Hello again and thanks for that swift reply. Will definitely take your advice on gentle massage. Insomnia a problem for you? In bed at 10.30 slept til half two when twin son came in. Tossed and turned and still awake now. Have read everything I can online about FMR and FM as feel I have had symptoms of both. Got my Qgoing book out by Michael Tse that is really worth a try as used it years ago for back pain and needed very very little medication as well as sorted out energy and felt great! Anyone else may find this useful as you can choose exercises which are very gentle and target the problem areas. Hope you really enjoy your time off and yes chillax and relax :-) Glad I found this.


Hi, sorry you had a bad night. I don't suffer with Insomnia. Did when pains first started and GP put me on Amitriptyline for pain, which I take 2 hrs before bed and "knocks me out". It is also one of the meds commonly prescribed for FM, although i dont have that. I will google QGoing I have never heard of it, take it easy today. Hope the steroids are starting to work.


Thanks for that. have been on Trazadone for a while it knocks me out in a similar way but not long enough these days. Just noticed I did not spell the book correctly sorry. It is Qigong for health and vitality Michael Tse. Good luck


One of our GPs suggested Tramadol when I told him that Co-codamol made me nauseous and in any case didn't seem to work on the pain. Tramadol, if anything, made me feel even worse. Can't take NSAIDs because I have a pre-existing reflux condition so am stuck with Paracetamol.


As others say that kind of rebound pain is not uncommon at all. I'd try to manage the heavy work days as best as possible you can, take rests if and when you can, and I'd bring in a heat pad or one of those beanbag things that can be microwaved for heat as heat always helped my PMR pain. Maybe if you are not doing something like this, try getting involved in a very gentle yoga class so that you are building strength and increasing flexibility to better cope with the extra workload as well (do it with someone who is not trying to get you to do stretches or poses you cannot do -- I found my yoga ability was far more limited but could do some and it really helped build strength). I woudn;t reduce when you are feeling bad already -- do the reductions when you are sure as possible that you won;t get a long shift in the next two weeks. On the up side - over time as my PMR improved, I found I could do more and more, and that these rebound pain incidents began to go away.


Unfortunately I do not have access to a microwave to hear my wheat bags up, which I use at home regularly. Has anyone tried the Thermacare heat patches which claim to give up to 8hrs of heat? I would consider Yoga with shifts it is difficult attending classes regularly, does anyone have a yoga DVD they could recommend that is not too difficult for PMR sufferers?

Thanks again for all the useful advice, I cannot thank you enough. I often feel alone as I look well my husband and daughter don't seem to appreciate the discomfort Im in, and I never raise the subject with them.


Hi again runrig01,

'Reduced to tears' eh! Well, that does it for me as far as your condition is concerned. You have to realise that you are seriously 'pushing it' as far as you illness is concerned. What you are risking is a serious flare in PMR which could mean that you are so debilitated that you will have to go 'sick'.

I do hope that you have a good GP. You need a good talk with your doctor regarding your work versus your illness. It is no good relying on your 4 days off to put your illness back in it's place. One day, it may be that the days off are just not enough to put you back on kilter and you could be in serious trouble. A letter from your GP might help your ward manager to be a little more inventive with your shift patterns.

You say that on your rest days you recover, therefore, perhaps it would be OK to try ibuprofen or another NSAID that actually gets rid of the pain on the days that you work.

Ask for a blood test to assess your kidney function. If they are OK then there is no reason why you cannot take a good NSAID for a short period of time.

By the way, I've tried 'stretching exercises etc' and all they did was make me more achy. It seems to me that you already get quite enough exercise at work. The only thing I would recommend is walking at a moderate pace outdoors for 20 minutes or so - it relaxes the system and gets the blood flowing round the body without too much stress.



Hi Pats,

I guess your right, l think my problem is on the good days it is easy to forget I have an illness. I see my GP in a few weeks before my next drop in steroids so will speak to him about the problems I am encountering at work. My kidney function is good, had bloods done recently, but will wait to speak to GP about NSAID for the few days I need it.

I do plan on making more time for short rest breaks on duty, in the past I make sure the rest of the team get a break. Often at the expense I miss out, I guess I need to stop being a Martyr :-?. Thanks for the talk, I promise I have listened, and am now accepting just because I have better days with Steroids does not mean I'm cured. Thanks again x


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