Prednisone and Opioids

Welcome @thomsoncat, There are quite a few discussions and member comments on opioids being used for pain but I'm not sure opioids will do anything to help the PMR go into remission. Here's a search link that lists the discussions and comments if you want to scan through them - https://connect.mayoclinic.org/search/?search=Opioids+for+pain.

There are quite a few members who also have issues with prednisone and have discussed using alternatives - https://connect.mayoclinic.org/search/discussions/?search=alternative%20to%20prednisone%20for%20PMR.

Have you discussed any alternative medications other than prednisone to help with the PMR with your rheumatologist or doctor?

Yes, we've discussed methotrexate and kevzara. My rheumatologist is not keen on kevzara and doesn't feel that methotrexate is efficacious for PMR. I'm using all the natural anti-inflammatories I can find. I will read the other threads, thanks.

I frequently see people with Crohn's disease who also have been diagnosed with PMR. Have you been ruled out for spondyloarthritis associated with Crohns?

Spondyloarthropathies have symptoms very similar to PMR. Nothing says you can't have PMR and spondyloarthritis together with Crohns.
https://www.jrheum.org/content/93/21
--------------------
I have both spondyloarthritis and PMR but not inflammatory bowel disease. I was blessed with uveitis instead of IBD.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7488890/#:~:text=Uveitis%20is%20the%20most%20frequent,of%20pain%20and%20blurred%20vision.
-----------------
How much Prednisone are you needing? I needed higher doses of Prednisone for a very long time. I had BP's as high as 210/110 when I was on higher doses of prednisone.

As far as opioids are concerned ... I give Prednisone credit for me not being addicted to opioids.

I would say you should try another one. MTX has not been as successful and takes a few months to start working. Kevzara and Actemra both seem to work really good for some and not for others. Dadcue posted a QA from Dr Megan recently where she suggests to keep trying. Lufudamide(sp)? LPN? One of them may work and will eventually be better for you than long term prednisone. Her comment was that statistically speaking prednisone has more long lasting effects than any other drug. good luck.

Thank you John.
I’ve only discussed DMARDs and pred. It is my understanding that opioids will not cause the PMR to go into remission. I was only thinking of using them short term during a taper. I’m having second thoughts, however.

Thanks Tuckerp.
I am now thinking to find a way to tolerate the pred until the PMR resolves. I need to send it into remission.

I’m completely asymptomatic on 10 mgs of pred.
I’m sensitive to it and need less that most folks. But I’ve been trying to taper for a year and the PMR is worse than ever on 4.5 mgs. So I’m going back up.
I’m just terrified of the pred side effects. The weight gain, increased blood pressure, etc.
I have had spondyloarthritis most of my life but my PMR symptoms are different; much worse.

"I have had spondyloarthritis most of my life but my PMR symptoms are different; much worse."
------------------------
I think a combination of things tends to have a cumulative effect. I could handle flares of uveitis with and without accompanying flares of reactive arthritis as long as I had enough Prednisone to take.

Having PMR on top made everything worse ... much worse. That was when I never had enough Prednisone to take. Now I don't take any Prednisone. Have you ever tried a biologic for Crohn's? Actemra allowed me to taper off prednisone relatively quickly. I suspect Kevzara might work for me too. Around 5 mg is when adrenals insufficiency from long term Prednisone use becomes a factor.

My Crohn’s has been in complete remission for years thanks to mesalamine. I am fortunate that way. How long have you had PMR and what are your symptoms now?

I had PMR for 12 years. My rheumatologist says I still have PMR but it might be in remission thanks to Actemra. No PMR symptoms currently as long as I do a monthly infusion of Actemra. I haven't needed any Prednisone for about 5 years except for when I don't get Actemra.

Reactive arthritis in many ways was worse than PMR but I flew under the radar of any rheumatologist or primary care doctor. I listed my ophthalmologist as my primary care doctor because he was the only doctor I saw for 20 years after my first flare of uveitis. I had more than 30 additional flares of uveitis after the first one. Nobody knew how much pain I was having because every time I had a flare of uveitis my ophthalmologist prescribed 60 mg of Prednisone. He said my uveitis was very aggressive and didn't hesitate to increase my Prednisone dose to 100 mg if the uveitis flare didn't respond to 60 mg.

My ophthalmologist and I had a great relationship because he saw me often. He said I was skilled with Prednisone tapers because I could get myself off Prednisone so easily. Going from 60-100 mg of Prednisone back to zero in a month or two was routine for me. My ophthalmologist never wanted me to run out of Prednisone so he prescribed boatloads of prednisone as long as I could taper myself off.

Whenever I had another flare of uveitis, I knew the routine. My ophthalmologist was impressed that I had a good sense of how severe my uveitis was. One particular uveitis flare was so severe I needed 100 mg to quiet it down. I said my eye was a "lost cause." I was sure I would be blind but I "didn't care" because I felt great. My ophthalmologist verified that I wasn't blind yet but said I should decrease my Prednisone dose because he didn't want me to "feel too good" about the potential for being blind in one eye. He said 100 mg of Prednisone was my limit but he could try something else. Fortunately my eye was beginning to respond to 100 mg of Prednisone and I dodged the more drastic intervention of injecting steroids directly into my eye.

I "self medicated" with leftover prednisone that was prescribed for uveitis. I had no idea what I was doing but prednisone certainly relieved all kinds of pain. Who needs a doctor when you can take Prednisone whenever you need to? During my 20 years of taking prednisone before PMR was diagnosed, my greatest fear was what would happen if I didn't have Prednisone to take. My greatest fear was realized when I was diagnosed with PMR along with everything else. After that, I couldn't find a way to taper off Prednisone for 12 years until Actemra was tried.