really painful ribs

Bones, joints and muscles
1

I started with a vomiting bug inthe early hours of yesterday. I slept for most of the day and forgot to take my pred. I fe

feel much better today apapart from really painful ribs. I was diagnosed with pmr a few months ago and fibromyalgia about 13 years ago. I have had rib pain regularly which I put down to the fibromyalgia. I think this flare is made worse by the retching (sorry) do any of you suffer from rib pain? The pain isn't at the sternum but on the sides going into the back. I can barely move at the moment and can't cough or laugh.

2

My bout of PMR has tended to relocate from one region to another, most recently migrating from the shoulders well into the frontal ribs, whichmakes for very painful sneezes and even some limit on how hard I can clear my throat.

I stay highly active however, and somewhat expect this latest symptom to clear within the usual few months.

Currently managing ok on 5mg pred @ 19mos (and 55 years), and I am one of the less-common sufferers to lose 15lbs and not gain any back.

Previously this ailment has caused a few months of discomfort to my knees, feet and thumb joints, in addition to the usual persistent hip and shoulder issues.

3

sounds a bit like you  strained a few  muscels   with  vomiting.

 

4

Hi Dan, I love to hear of those who have actually LOST weight while on Pred. I was skinny enough to begin with and then lost around the same amount of weight as yourself.  . . It's funny really, if either of us was overweight and then experienced this side-effect, everyone would be telling us just how well we look!!  Instead people remark on the weight loss . . . . I find it quite depressing especially as it's so hard to put it back on . . .  Cheers (anyway), J.

5

The weight loss seems to have resulted from the PMR, early on.

My Prednisone treatment started some months into it, by the time I began on 15mg of pred.

I can't recall a single prednisone-specific symptom, only a loss of pmr symptoms from taking pred.

The pred does however seem to eliminate my severe seasonal allergies, even at just 5mg, and also reduces the normal post-exercise stiffness I would ordinarily endure after hard cycling in the hills here, something I still enjoy.

6

Could someone clarify about having both PMR and fibromyalgia? What symptoms does one have with fibro that are not PMR symptoms?

I thought fibromyalgia was just a catch all because doctors can't nail down what the patient has as the source of the symptoms.

7

What happens if you miss a dose?  Does it set you way back?  Can you take it hours after it was due?  Just curious in case it ever happens.  

I lost 23 lbs from the PMR which brought me from a medium size to small or a snug 10 to a 6.  I was starting to be concerned but I think it's stopped now.  Been the same for about a month.  Went on prednisome in March.

Sometimes, I feel a little lightheaded sort of like my head is screwed on backwards but if that's the worst I can live with it.  I had two flares at 10 mg so I'm on 23 mg now from 25mg. Going to take it a lot more slowly this time.

8

I have missed a few daily doses over my 18mos of treatment, and hardly noticed at all, with at most a temporary increase in symptoms.

9

Deborah, I had a severe bout of rib pain at one stage of my PMR/GCA journey, also intermittent bouts of painful shins, leading me to wonder at th time whether Fibromyalgia was joining in the fun.  But I agree with Dan that PMR pain does often seem to pop up in different parts of the body for a while and then move on somewhere else.  However, in your case at present I think your pain is far more likely to be strained muscles from the vomiting, borne out by the fact that coughing or laughing is painful.  I hope you soon feel better.

10

Karren, with Fibromyalgia applying pressure to certain parts of the body can trigger pain.

When suffering from both PMR and Fibro at the same time, it can be difficult to tell the difference especially if you haven't experienced either one on their own previously and got used to recognising the symptoms of each.

A list of comparisons was published by the Fibromyalgia Association UK a few years ago which may help:

Polymyalgia

Affects people over 50 years

An inflammatory condition

Symtpoms of severe pain, stiffness and tiredness

Can be accompanied by inflammation of the arteries

Treatable with steroids

Responds well to treatment

Many side effects of steroid treatment

Good prognosis - generally lasts 2-3 years

Fibromyalgia

Affects people of any age

An abnormal pain processing condition

Symptoms of widespread chronic pain, persisten fatigue and non-refreshing sleep

Many associated symptoms including cognitive dysfunction, IBS and anxiety

Treated with analgesic painkillers, low-dose antidepressants and lifestyle changes

Treatment response is variable

Variable prognosis - symptoms can improve but can last many years

11

Simple definition of Fibro and PMR

Fibromyalgia causes symptoms related to nerve pain.

PMR (which means many muscles in pain) causes pain in

muscles and connective tissue......due to auto -immune

inflammatory disease.

Like I said,   very simple explanation

 

12

One cause that often appears alongside PMR is myofascial pain syndrome - it is concentrations in trigger points of the same cytokines that cause the generalised pain and stiffness in PMR. They stay there permanently until dispersed, in PMR they are shed into the circulation every early morning, causing the morning stiffness.

One position of the trigger points is on either side of the spine at about rib level. Others are in the lower back and in the shoulder muscles. They can be identified as knots in the muscles, the muscles are tight and can even go into spasm and can pinch nerves causing referred pain a well as being sore themselves. The shoulders lead to head and neck pain or even into the arms, the low back ones can cause upper leg pain as well as low back pain. It can be all levels, from constant ache to excruciating spasm when you can't move.

The trigger points can be dealt with using manual mobilisation - which tends to release the cytokines into the circulation so you can sometimes feel quite rubbish for a day or so. It took months for a massage physiotherapist to deal with mine years ago! If you catch them early it can be quite fast though. Another technique is cortisone injections close to the trigger spot which eliminates the inflammation. And my favourite of course - Bowen therapy can also make a BIG difference.

Your back muscles are very forgiving and will adjust to take account of a lot of things from wearing high heels to walking badly as we tend to do in PMR - eventually however they give up the unequal struggle and go into spasm - to try to stop you doing something they can't compensate for. It can be as little as catching your head on the door as you get in or out of the car, the bus stoppping suddenly and you don't, tripping over a kerb and trying to save yourself - or a nasty attack of D&V when the retching overloads them and they protest.

It is being considered by one of the research groups whether dealing with apparently non-connected pains like the ones described in this thread can contribute to needing a lower dose of oral pred longer term. It certainly has for me - Once this was all sorted out 3 years ago I have reduced steadily to 5mg. I'd never been able to before. The orthopaedic specialist who gave the paper from which I learned about MPS said he finds it quite often in patients with PMR - and it needs to be considered separately and dealt with. It often fades at higher doses of oral pred but then returnes as the dose is reduced or appear for a short time with an extenal event like those I described.

13

eileen that was a very intersting read myofasical pain. that explains  my early morning pain in my shoulders.    relating to bowens therapy.how does it work , meaning,  is it done in the one  place  where the pain is,   like  massage on the  shoulders so  that  just eases  the pain in the  shoulders or does it  work all over the  body pains   sorry for been a  bit  thick  on this matter

 

14

just one more  question eileen    how long  have you  had  pmr. and been on pred    at what doeses   just gives me  an idea    os how im  getting on

    thanks

 

15

If you google mitchell mosher podiatrist bowen therapy video you should get a link which shows what they do. It looks wierd and as if it would achieve nothing but I feel differences during a session. My lady also has a website - Joanne Hewitt Bowen therapy Durham will find it and her explanation.

How does it work? The lord only knows but it DOES work - ask lodger! It is supposed to realign the muscles and their attachments and stimulate them to "heal" themselves, or at least stay where they should be  Joanne always says that if it is going to work it will be apparent within 3 session - lodger walked out of her first session and forgot the walking stick she'd needed to get in an hour earlier! 

I've had PMR for well over 10 years now. They had no idea what it was and for 5 years I managed with nothing but the odd ibuprofen tablet but did aqua aerobics in the morning whilch got me moving, Pilates once or twice a week (adapted) and a yoga class (also adapted) and bowen every few months. Then PMR hit like a 10 ton truck not long before we moved here where the aqua and pilates are only a VERY expensive option that would cost a small fortune. I eventually was given 6 weeks (only) of pred to cover a trip to the US and 15mg provided a 6 hour miracle. The rheumy wouldn't listen, he wanted it to be anything but PMR, but a different GP who had only been parttime when she was there and had mostly been on maternity leave recognised it immediately. Soon after we came here.

Just over 3 years ago I had a major flare - the type of corticosteroid they use her just didn't work for me and that combined with myofascial pain syndrome had me in hospital. Then they put me on a statin - one week and I was in a state of collapse! I stopped pdq. The treatment I got then sorted all the MPS out but the PMR was still something of a pain until my GP put me on another sort of pred which worked as well as the original prednisolone I'd had in the UK. Using the "Dead slow and nearly stop" reduction I've got down to 5mg - I've been down to 4mg but feel far better at 5mg. It's the slow reduction and tiny steps that has made the difference I'm sure.

Can I get lower? I'll be trying but not forcing anything. My GP is perfectly happy with me at 5mg so doesn't make a fuss. I don't see a rheumy, don't need to as she is rheumatology trained.

You can't compare yourself with anyone - your journey is for you alone. It might all be done and dusted in 2 years - or it might be 5 or even 7 or more. PMR came when it wanted and it will go when it wants - nothing you or anyone else can do will change that. Your job is to make the best job you can of finding the lowest dose that manages YOUR symptoms - not anyone else's. Just because Mrs Positivethinkingcuresall says it only took her 6 months - you aren't her...

16

I have both like yourself...fibro/PMR I don`t get the rib pain that you describe, but my sister does, who has neither.  She has gallstones...so not everything is down to our usual problems...it could be that...get it checked, if it dosen`t disappear...hope this helps...

17

Myofacial Pain Syndrome was what my 2nd rheumy insisted I had. The only treatment being NSAIDs which you can't do forever. The Tylenol & Advil helped keep the pain under control but it wasn't working toward my goal of getting out from under the ailment.

Are neck and shoulder pain not part of PMR?

Anyway it seems the only way to know if you have PMR vs MPS is to try the prednisone for a couple of weeks to see if you get a dramatic Improvment. The doctors are looking for a 70 percent improvement.

18

Yes, shoulder stiffness and pain are part of PMR for most people - but for me there is a difference between the PMR problems and those caused by MPS.

NSAIDs are NOT the only treatment for MPS - in fact, they do very little and don't target the cause of the pain, just mask it. Physical therapies and targetted injection or needle therapies are particularly helpful but not always easy to get - they are available in the USA, are almost unheard of in the UK and common in mainland Europe (I've had them). If you google it and look at the Mayo Clinic site you will find quite a good article which describes the various options and points out you may need to combine several to get an optimum result. 

Interestingly - while reading through the Mayo article they say some people think MPS may progress to fibromyalgia which was something I had never come across before. Earlier on someone asked about the difference between PMR and fibromyalgia - the fundamental difference is that most of PMR pain responds to 15-20mg of pred, fibro pain does not. There are a lot of overlaps, I had pain in about 12 of the trigger points they quote in fibro and I had pain when pressure was put on muscles - but that is also listed as a symptom of PMR. I responded like magic to 15mg of pred and, since I had managed the MPS and PMR for some years, to start with I was fine. Having moved here to Italy I had given up the self-management things as they weren't available or affordable here and gradually they built up again. The Medrol (methyl prednisolone) I was put on as the standard corticosteroid here, didn't work for me and I developed a major PMR flare, ending up in hospital. Using the techniques mentioned in the Mayo article, the pain clinic here were sorting out the MPS part and then I was put on a form of prednisone - and had the same magic PMR response I had had originally, more than 70% improvement in a couple of days. As the MPS improved with manual physiotherapy techniques to mobilise the trigger points together with needling techniques and injections, I was also able to reduce the oral pred. Now I have almost no MPS problems and the PMR is also well managed at 5mg.

To achieve freedom from pain you have to deal with the underlying causes of MPS and it can be done. Depending on the rest of your medical history it may return - it can be due to poor posture or other things, like PMR, which lead to muscles being put under strain - and then ongoing therapy is required. It may not be every week, maybe every few months or even, if you are lucky, every year or two. Those of us who use Bowen therapy also tend to have "refresher" sessions - sometimes because of a twinge or pain but also prophylactically every 6 months or so. Some people treat themselves to a massage or a facial - I enjoy a couple of sessions of Bowen as if it were massage as it leads to a floating feeling or well-being for me. I'm not the only one.

It isn't uncommon for rheumatologists or orthopaedic specialists to say muscle disorders such as MPS and its effects can't be cured - physio or physical therapists often have a very different view. It was said to me - and the physio I saw when I was in hospital was horrified. Had I seen her rather than the doctor I would have had far less pain over a 2 year period. But our system has an exemplary pain clinic which doesn't just teach people to manage their pain - where possible they will target the cause of the pain. The anaesthetists who run it are sent for courses on these techniques, something for which I am heartily grateful!

19

Thanks, Faye, the simple difference is quite telling.

I was sent to a neurologist for an EMG and other tests and the result was I didn't have any nerve issues. So that ruled out fibermyalgia for me I guess.

Is there a simple way to tell the difference between PMR and Myofacial Pain Syndrome? Maybe this is where it gets harder. My second rheumy was hanging on to MPS as my diagnosis when he could have ruled out PMR by encouraging me to take the the prednisone. Doesn't this seem like a no brainer?

20

Eileen,

thanks for the clarification and I definitely misspoke about MPS and NSAIDS. What I meant is that it has no miracle med like prednisone to help stop the symptoms.

Have you heard of something called "dry needling"? My PT group does dry needling to release trigger points. 

Also when I get acupuncture treatments, sometimes my acupuncturist hits a trigger point which provokes a much bigger reaction than the points she usually treats in the acupuncture meridian system.

Acupuncture before I got the pred med, was providing much more relief than anything else I tried. The only problem was its last power was short --a few hours to a day.

Another thing I have been using is cho pat strap which is a band that presses on a tight muscle in the leg. After walking around a bit the muscle tends to release and the pain diminishes or goes away.