Suggest Treatment For Severe Pain While On Prednisone

Posted on Thu, 13 Apr 2017

Question: My CRP was 3.5. Seed rate normal. All other labs normal. I was strong and healthy. Thought I had polymyalgia rheumatica And take 10mg prednisone bid. It got better but every time I work out I'm in terrible pain the next day. I've been on prednisone since 2/28. Biopsy revealed negative for GCA. What do you think? I'm a nurse

Answered by Dr. Panagiotis Zografakis (55 minutes later)

Brief Answer:
your symptoms?

Detailed Answer:
Hello,

you haven't described your symptoms and the diagnosis of disorders like polymyalgia rheumatica is based on clinical data mostly. A low ESR is very much against polymyalgia rheumatica (or giant cell arteritis). Fibromyalgia does not require a high ESR and can be associated with muscular pain (if that's your main symptom). Low vitamin D is another (more common) cause.

So please inform me about your symptoms first...

Kind Regards!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Panagiotis Zografakis (22 hours later)

My symptoms are muscle pain. Neck, shoulders, legs

Vitamin D level is fine.

Answered by Dr. Panagiotis Zografakis (1 hour later)

Brief Answer:
more details please...

Detailed Answer:
So vitamin deficiency is out of the question...

Please describe your symptoms in more detail. For example:
- does the pain come and go?
- does its intensity fluctuate?
- is there anything that makes it worse? (movement, stance, anything at all...)
- anything that makes it better?
- do you feel weak? Are you weak (objectively)? Can you get out of a chair easily? Can you climb the stairs as you used to in the near past?
- have you checked the trigger points of fibromyalgia? Do they match with your sore areas?

Any test report may help... Please upload what you have. A good quality photo would suffice. You can send them directly at my email address if you'd like ( YYYY@YYYY ) or upload them here. whatever seems easier to you.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Panagiotis Zografakis (12 hours later)

The pain comes and goes, is worse after movement, I don't feel much weaker-can still climb stairs etc. pain is what's restricting me. Intensity fluctuates. I don't have the list of symptoms of fibromyalgia: sleeping fine, not tired, memory okay, not heightened pain with pressure, no anxiety, nor restless legs or bladder/bowel issues. I was a strong and healthy exercise enthusiast until this struck.
Thank you

Answered by Dr. Panagiotis Zografakis (1 hour later)

Brief Answer:
it can be fibromyalgia still

Detailed Answer:
Although you don't have the full spectrum of symptoms, you may still have fibromyalgia. Please understand though that this is a diagnosis that's 'confirmed' by excluding other diagnoses. You can check this link which is very useful to get a pretty good idea of fibromyalgia and its differential diagnosis. You don't have to experience all the symptoms. Sometimes it's only the pain. There are some 'sensitive' areas in fibromyalgia. Palpation over the sensitive areas may elicit pain. Your doctor should do that for you (if it hasn't been done so far). The link I've sent you includes information about the proper technique to do that.

Other causes of pain have to be eliminated. A normal CPK, aldolase and electromyogram to exclude neuromuscular disorders, normal vitamins B12 and D, drug side effects (like statins or other drugs; even supplements may cause trouble), normal serum electrolytes (sodrium, potassium, magnesium, calcium), etc. Corticosteroids do not help unless there are coexisting disorders.

I hope it helps!
Kind Regards!

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar