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Suggest Treatment For Severe Lower Back Pain In An Elderly Person

Posted on Wed, 15 Feb 2017

Question: Hi,
my 91 year old mother in Germany was prescribed Prednisolone oral for left lower back pain traveling into her leg. She is supposed to take one pill at lunch and half a pill in the evening. She started taking it on Thursday. First she started to feel better but then today it got worse, her response is to not take the half a pill at night. She is also disturbed by reading about all the many side effects (!) and so am I! I told her to consult the doctor about reducing the dosage first thing Monday morning. (I'm in the US and tried to reach the doctor, haven't heard back yet.) My question for you, is it dangerous for her to do this reduction on her own? Again, she just started taking it.
She was diagnosed with Spinal Stenosis when she was 80, got a series of cortisone injections and the symptoms disappeared. There was one more recurrence in her mid-80s which was also successfully treated. She does her own morning exercises regularly and also received acupuncture successfully over the years. Any advice on how useful or dangerous this prescription is and alternative suggestions?
Thank you very much!
Eelka

Answered by Dr. Shoaib Khan (1 hour later)

Brief Answer:
No problem in reducing the dose by self

Detailed Answer:
Hello Eelka and welcome.

Thank you for writing to us.

I have gone through your query with diligence and would like you to know that I am here to help. I can understand how some of the listed side effects are worrying, but this medication is used by many people for various reasons and the more troublesome side effects are experienced in only some.

No Eelka, it will not be dangerous to reduce the medication on her own as this is not a habit forming medication that requires gradual weaning off. Other than the fact that her pain might get worse at night (as she is discontinuing the night dose), there should be no other undesirable effect of reducing the dosage of this medication.

I should also let you know that both cortisone (injections that your mother has been administered in the past) and prednisolone belong to the same group of drugs (i.e. glucocorticoids), and have more or less the same effect and side effects.

The only difference is that the doctor has chosen to treat her in a more comfortable manner at home by prescribing an oral glucocorticoid (e.g. prednisolone), instead of prescribing an injectable glucocorticoid (e.g. cortisone). So the prescription is not very different from what was given when she was treated in the past.

I hope I have explained things in a manner best understood by you ma'am. Please feel free to write back to me for any further clarifications, I am always here to help.

Best wishes.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Shoaib Khan (1 hour later)

Thank you very much!
What do you think could be the reason that her pain got worse after she took the medication for two days BEFORE she reduced the dosage?
Thanks,
Eelka

Answered by Dr. Shoaib Khan (6 hours later)

Brief Answer:
Psychological or the causative factor providing an increase stimulus

Detailed Answer:
HI Eelka.

The possibility of pain increasing after taking the medication is highly unlikely, and so I do believe it is either psychological or the pain from the cause would have increased.

There is nothing to worry about, and if she is comfortable this way, then that is all that really matters. But the doctor would have prescribed the night medication just so she can rest and sleep peacefully without having to experience any pain or discomfort, so do speak to the prescribing doctor for a solution.

Best wishes.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Shoaib Khan (6 hours later)

Thank you, Dr. Khan!

I just spoke to her today. She did have a bad night (!) but strangely enough it "came" from the ankle traveling into her shin (?) We both think that it must be related to the diagnosis but she also thinks it could have been aggravated by unusual shoes that she was wearing yesterday that squeezed the top of her feet . . . Now, however, during the day she is "feeling much better" while, of course, it's not gone.

I explained everything that you told me and she was very grateful for it! She now says that she will take the half pill for the night and even the day pill tomorrow and then call her doctor.

I also learned today that she actually stopped taking the medication already Friday night because of her fear of side effects. I had misunderstood! So she only took the full dosage on Thursday and then the day pill on Friday.
Based on your explanation, at least that choice would not have harmed her, other than the pain . . .

Please let me know, if you have any other insights for me.

I'm really grateful for your support and hope that my mother can consult with her doctor tomorrow!

Thanks again,
Eelka

Answered by Dr. Shoaib Khan (20 minutes later)

Brief Answer:
Sad to hear she had a bad night, hopefully things go uphill from here

Detailed Answer:
Hello once again Eelka.

So she did have a bad night, and could have been triggered by the footwear that she is suspecting, but it could also be because she chose not to take the night dose (did she?).

That is good to know. Eelka, we both need to understand that given her age, we need to provide her with as much comfort and ease as possible, and at her age, she shouldn't have to suffer with pain and/or sleepless nights. So if she does take the pain medications and find relief, then it would be good.

I am glad you now have a more clear perspective on the situation.

My only advise now would be to speak to her doctor and find a more agreeable solution or medication to help her live her life with comfort. But Eelka, please do not hesitate to write to me about anything, I am always here to help.

Best wishes.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Shoaib Khan (3 hours later)

Thanks so much! I appreciate your help.

I'd like to hold off from "closing the discussion" until my mother and/or me have talked to her doctor tomorrow.
Thanks for understanding,
Eelka

Answered by Dr. Shoaib Khan (11 hours later)

Brief Answer:
Of course Eelka, no formalities please :)

Detailed Answer:
Hello once again Eelka.

Of course, you need not ask me for that, I shall remain at your service for as long as you need me to. Please feel free to write to me anytime and for as long as you want.

Best wishes.

Above answer was peer-reviewed by : Dr. Nagamani Ng