Hi all, 71 year-old male, 5th year into PMR, and have had a relatively easy time with it so far. Started at 50 MG, got down to 0.5, and had to up it to 1.5MG about a month ago. I've had a few minor flares, but nothing major until this AM. Some background: I damaged my rotator cuff about 6 weeks ago while using a chainsaw to clear up some brush. Since then, everything has gone to pot. Shoulder pain and fatigue -- a lot of fatigue. But it's been 6 weeks since the injury, and the pain of the rotator cuff injury is a bit better -- so yesterday I went outside and returned for a small bit of yard work. I used a chainsaw, loaded some pine branches onto my pickup truck, and hauled them away. Remember, I had been doing this for weeks prior to hurting my rotator cuff with no PMR side-effects other than the rotator cuff injury. But last night was awful. I moaned turning in bed. This AM I felt like I did 5 years ago when the PMR rose its ugly head. Everything hurt. All my muscles, my joints -- everything. And the fatigue is debilitating. After a lot of thinking, I decided to take 5 MG of prednisone. So far, only minimal improvement (after 4 hours). So what do you think? Should I keep it a 5 MG, go higher, or go back to the doctor (who is trying to get me off the prednisone?) Thanks all you marvelous people!
What does your GP say? Some, when a small increase doesn’t control the pain, are advised to go to 20 for a short ( no more than two weeks ) and then try again to reduce.
Not meant as advice, of course… just for consideration. Worth an ask.
I’ve never used a chain saw but do use a strimmer that hangs on my shoulders via a belt. I know I could not have used it while on PMR with its muscle weakening side effects. It does seem unfair that those of us who have always been active don’t seem able to transfer our muscle strength while on Pred.
To finish on an encouraging note… I had PMR for five years was able to resume a lot of my physical work within 18 months of getting to zero Pred.
Hope you soon feel more comfortable.
hi Bob, so sorry to hear of your setback.
I’m definitely not a doc., but based on what you’ve said, I have a “gut” feeling this won’t be a long lived thing–(do lay off the chainsaw for awhile
)!
If it were me, I’d go up on dosage (maybe 15mg) till I could confer w/doc.
good luck and SLOW DOWN!!
Lynda has it in one: lay off the chainsaw for a while!
Pred doesn’t work as a painkiller when you have seriously overdone it and are suffering from delayed onset muscle soreness which is what I suspect is your problem. You may be having a flare - in which case you may need some more pred but I doubt that is your main problem.
Both PMR and pred don’t do your muscles any good - it is your responsibility to pace and rest appropriately and try to avoid this sort of situation.
Six hours later, and I’m feeling much better after taking 5 mg (instead of my normal 1.5). I do know the difference between muscle soreness and PMR – and this was definitely PMR – all the classic symptoms I had when originally diagnosed. It included joints as well. I could hardly stand up.
I have to be careful about going to the doc, because he’s one who promotes getting off prednisone ASAP. He’d scold me for going up to 5 mg, and he’d insist I go back down to 1.5 immediately.
So my plan is to go to 4 mg tomorrow, then 3.5 the next day, then 3.0, then 2.5, then 2.0, then 1.5 where I was when all this started.
I do think that my rotator cuff injury triggered all this. I have never had to fight fatigue until that injury and have always been able to do quite well with exercise and yard work – again until that injury.
Isn’t it possible that flares can be triggered by another injury?
Personally I wouldn’t take pred for this. You know what caused your pain - overuse of weakened muscles - and what will make it better - time and care. Pred is pretty serious medicine and I don’t think it should be taken unless really needed.Do what you would do if you didn’t have PMR and had no access to pred. 
This is hard to understand.
What is a flare?
Aren’t flares caused by something?
Could not this flare have been caused by an injury?
Haven’t I read here that people increase their dosage if they are ill, know they are going to be stressed out, etc?
Again, I’m not sure I understand.
Thanks for the warning though. I am paying attention.
I am with you on this being flare caused by injury. Logic is that injury used cortisol and your adrenals are not yet up to normal function and cannot produce cortisol as much as it is needed. If Iwere you I would stay on 5mg for few more days and then go back straight to 2mg or so. If your increaseis short ( few days) there is no need to taper.
As far as fatigue, I can tell yo that I after 3.5 years of PMR and very active life it is first time that I feel fatigue at as I tapper below 2mg. I think you are in similar situation. What I do is after yard work or exercise I take 30min to 1hr nap to recover and then the rest of the day is much easier.
I guess I’m a bit more conservative, also reluctant to take pred if it might not be needed. This is because I almost certainly now have a degree of pred induced muscle weakening and I would dearly love to be able to stop taking pred altogether, but I know PMR is not in remission. In a case like yours I’d likely wait it out for a few days, and only increase pred if the normal, albeit right now slightly slower, recovery from muscle overuse didn’t occur. I do sense that some patients immediately always spring to a higher dose of pred and I personally would be afraid to do that unless I was sure it was the PMR symptoms increasing.
Yet another school of thought would say that by taking extra pred for a few days you are preventing a potential PMR flare which would be a sort of delayed reaction to your initial overdoing it.
So, it’s your body, you alone know what’s best for you. I guess my short answer would simply be, don’t be afraid to use more pred if you need it, keeping in mind that it is a serious medication.
All the best!
I do understand your point of being on a causes side and let the body recover, rather then increase the dose. But if you carefully read Bob’s post, he said that after so many years of PMR he knows the difference between muscle pain and PMR pain and he considered this to be a PMR like pain - thus my post.
On a flip side of things, one may be jeopardizing adrenals recovery by not letting the body handle extra stress. How else will they “learn” to react to stress? Both points are valid.
It’s taken me a long time to do as you are doing and pace myself. I have until recently been a " How much can I fit into this day?" person and change does not come easily Some of us become more cussed with age. Enjoy you nap! Will try to remember to join you.
Everyone has to find their own way to deal with new reality. That is the key “secret” when you live with PMR.
I want to thank all the people that posted to my question.
I am very fortunate to have had a rather easy PMR journey, and I credit most of my ease to the generous people on this forum – people who I listen-to regularly.
Thanks again. You are truly marvelous people.
I wish I could be sure of the difference myself now. It used to be clear what pain was what, and now I never really know, I think old age is beginning to crush me. And I thought Bob was posting because he wanted advice, that’s all. I gave it, from my point of view. I think pred is damaging me and I’m always concerned now when people may be taking more pred unnecessarily.
Anhaga,
I WAS asking for advice, and I am grateful that you gave it.
I’m also with you – my “philosophy” is to wean off prednisone (and any other medications) as soon as possible. I hate the thought of anything in my body that was not put there naturally.
Keep giving advice Anhaga. It’s appreciated.
It does give the spirits a lift to know that here we all are, never having nor likely to meet. No financial interest, no sign of ego boosting, just a willingness to share what we have experienced in the hope it will be a help to someone.
A holiday where we can recuperate from the ills of the “real” world. Stick around everyone.
Don’t be hard on yourself and don’t give up. Yes, old age is sneaking upon us while we are busy taking care of PMR, but we are fighters. Keep smiling in spite of all… It feels better then wallowing .
I’m in a similar situation to Bob at the moment. I injured a shoulder, no chain saw involved tho :-). The pain in my head, neck, shoulders and butt area, just got worse for over a week. I felt worse than I did when I was first diagnosed, with the same TYPE of pain that came with PMR. I was on 5mg at the time. I was away and needed to fly home for a few hours next day. I was concerned more about the frontal head pain so I took 10mg the day before I flew. By mid morning next day I was feeling amazingly relieved, so I thought that would definitely indicate it was a flare. I went back to 5mg next day, but a week later I am back in the same painful situation. I am off to my Doctor tomorrow to get ADVICE this time. My Doctor is like your Doctor, Bob. I expect I will get scolded too. Doctors main aim is to get me off Prednisone. I have to toughen up and get more assertive , because I already feel like a naughty school child before I go. I will let you know what advice I get from the paid professional.
I am thinking the same as you at the moment Bob. Did my injury bring on a flare of PMR ? Extra Pred relieved PMR type pain in less than 24 hours.
We are all caught between the Devil and the deep blue sea aren’t we ? To take more or not to take more. Sometimes I think I wait too long. It is like gambling. Will I take it, wont I take it. Your concern about people taking too much, too soon is valid. We need to be reminded. Thanks Anhaga.