Hi- I don’t think it’s “impossible” to treat everything, but it sometimes feels impossible to me—mainly because the medical system is so siloed, many specialists are reluctant or lack the time or motivation to try to learn more about things they’re less familiar with and deem it “out of their scope of practice,” and in general our healthcare system is not set up well to not address non-linear pain conditions, and even when they’re are proven treatments, they’re hard to access! But…that could also be because I feel really jaded right now.

It’s probably difficult to have one thing (if the one thing is a medication) to address every problem. For things that are more systemic, like maybe the neuromodulators that affects pain perception, chronic pain PT or programs, CBT, meditation, etc… It’s my opinion (and probably shown somewhere) that those strategies can improve many conditions. Would it cure everything though? Probably not.

But..to answer some of your questions >_< Yes, I have multiple autoimmune conditions. I have seronegative spondyloarthropathy (I don’t have a more in-depth classification than that. I don’t know why but it’s rarely described anywhere but in a few articles I’ve found.) I also have POTS and small fiber sensory and autonomic neuropathy (and hypermobility syndrome disorder and fibromyalgia).

There’s no way to be certain, but my POTS and small fiber neuropathy are assumed to be autoimmune because I also have spondyloarthropathy that responds to a TNF blocker. It’s impossible to figure out which came first.

As someone who’s also spent a lot of time in the “pain neuroscience” world, I also feel it’s also possible there is so much overlap here because chronic pain, especially if not addressed quickly and well causes changes to the central nervous system (brain) that can then trigger other conditions. It also seems reasonable to me that if psychological trauma is shown to cause changes in people at a cellular level, why wouldn’t the chronic stress of chronic pain…? But that’s…getting away from your questions >_<

I think you’re right and prednisone is non-specific (as opposed to a TNF blocker), so it can improve—or mask—symptoms of many things (we have run into that problem many times with my dad, who has PMR and had a severe stroke. It’s really hard to tell if an improvement or problem is related to prednisone or something else.)

For me, the approach has been to go after the treatments that are likely to help multiple things. I tend toward those options anyway because if my values and preferences, so PT grounded in pain science is a cornerstone of my treatment. And when there are effective and safe options available that are targeted to my specific problems, we’ve incorporated those things. PT without the TNF blocker wouldn’t and didn’t work for me.

I feel like I’m sounding really confusing. But I guess I’m saying we’re doing a mixture of all the things that feel most effective and fit my values—going broad when things are more broad and going after my most limiting symptoms when we can. I like to find “the best tool for the job” (which is probably different for everyone when you get to gray areas where there may be multiple options) when I can, i.e. I couldn’t function with the chronic tendon pain from spondyloarthropathy, so I needed to do something more with medication and we had to try the TNF blocker. I also have chronic pelvic pain, so I’m in pelvic PT. I have GI symptoms, so I work with a GI dietician.

At the moment, I’m considering IVIG infusions because there’s some limited research to show it could treat the type of small fiber neuropathy I have. A previous neurologist said on-going research suggests it could also improve many of my other conditions, if they’re autoimmune, so maybe that would fit the bill as something with more broad effect, but there’s very little solid research right now. So we don’t even know if my insurance would authorize it.

(Also…disclaimer, I don’t have PMR; I follow the group because my dad has PMR, and I’m a caregiver. There is an autoimmune group on Connect though too).

Hope that helps and doesn’t make things more confusing?