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Sciatic problems
I’ve had PMR now for about 4 1/2 months. Took quite some time before I was correctly diagnosed. Started at 20 mg of prednisone and have now worked down to 12 1/2 mg.
Very early I had no more symptoms from the waist up. I have not been able to rid myself of problems from the waist down. After three or four or five weeks, I had a pain in the legs caused by sciatic nerve. I have had sciatic problems before, so I’m quite cognizant of how it feels. In the past, I have always been able to alleviate the problem through sciatic nerve, pacific, exercise, and walking and so forth. This time Iwas prescribed physical therapy. It seems to eliminate the sciatic problem for that day, but starts from Ground Zero again the next morning. I also have spells of dizziness and weakness in the legs, and of course, unsteadiness. I’m trying to figure if this is an extension of PMR, or is the sciatic nerve problem a separate issue? I now take Tylenol starting in the morning with two 500s and then two or three more during the day. This almost eliminates the sciatic problem, but doesn’t do anything for the dizziness and most of the weakness in my legs. Also experiencing a lot of buriness my eyes, which was first diagnosed as dry eye, and prescribed drops and hot compresses. This would make it go away for short periods, but the next day was back to Ground Zero again. I have stopped using drops and hot compresses as the condition seems to be constant no matter what I do. Again PMR?
I am 85 and until PMR was in better than excellent health. I shot the best game of golf in my life the month before PMR started. I biked, and exercised a great deal of the time. And was able to do almost anything I wanted to. Now I’m very limited. I need some ideas Hopefully to take back to the doctor.
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Do you have sciatica or radiculopathy?
https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/sciatica-and-radiculopathy-peculiar-names
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I have a bit of both. Actually, I have more radiculopathy than sciatica.
Sciatica is named for the sciatic nerve and that nerve usually isn't the source of the pain referred to as sciatica. You may need an MRI or at least an electromyogram (EMG) and nerve conduction study (NCS) to correctly diagnose the source of your pain. The distribution of your sciatic pain depends on which nerve root is affected. It is rarely due to irritation of the sciatic nerve itself.
It is even more rare for the pain to be caused by piriformis syndrome that is attributed to PMR by some people. Those people can't even order an MRI and/or EMG/NCS tests to ascertain the cause of the sciatica.
https://my.clevelandclinic.org/health/diseases/23495-piriformis-syndrome
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I'm the same as you ... from the waist up, I have no problems in spite of 12 years of PMR. From the waist down I can't walk very far or stand for prolonged periods of time. My symptoms of leg weakness, foot drop and all the numbness and tingling are mostly caused by nerve damage. due to severe lumbar spinal stenosis. The inflammatory pain caused by PMR seemed to compound the inflammation being caused by spinal stenosis.
Even though prednisone relieved the pain temporarily it would come back and be worse the next day. It wasn't until, I developed severe leg weakness and foot drop that I realized it was something new. The pain got so severe I went to the emergency room "with acute onset neurological changes." Only when an MRI was done did I learn that I had severe spinal stenosis.
I remember thinking I was having a PMR flare until I started having leg weakness and foot drop. The severe pain that accompanied the neurological changes was relieved by 60 mg of Prednisone. I dodged the emergency spine surgery that was being planned.
The surgeon said I wasn't a good surgical candidate because of my long term history of Prednisone use for PMR. I still have significant nerve damage that won't ever improve. Prednisone was doing a good job of masking the pain because I told the spine surgeon that I didn't even know that I had a "bad back."
Inflammation contributes to the pain caused by spinal stenosis and Prednisone helps to relieve the pain. However, the damage caused by compression on the spinal nerve roots can be permanent.
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2 ReactionsI had vision changes while taking Prednisone, cataracts and a switch from farsighted to nearsighted.
I developed lumbar spinal stenosis after some heavy lifting and yard work a year into treatment for PMR. It was coincidental to the PMR but maybe exaggerated by the prednisone side effect of bone loss. An x-ray of the lumbar region revealed anterolisthesis L4-L5, grade 1 retrolisthesis L2-L3 and L3-L4 and widespread degenerative arthritis. The pain and numbness has mostly resolved if I limit the heavy lifting and twisting. I am 76 and not too happy about having to act my age, my body is wearing out and I need to accept that as gracefully as I can, (not too gracefully yet, lol). It might be a good idea to have a lumbar x-ray to get some idea of what your spine looks like. I found these exercises worth doing:
https://www.verywellhealth.com/exercise-program-for-spinal-stenosis-2696100
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2 ReactionsI have severe lumbar spine issues involving central canal stenosis, foraminal stenosis, vertebra out of alignment, several herniated discs and compressed nerves. This all causes an almost constant ache on my left side which occasionally leads to sciatica down to the knee. With PT, I have learned to manage it. No BLT (bending, lifting, twisting), which means most of these exercises would aggravate my symptoms. The ONLY thing that helps greatly is standing back extensions. If I’m being good, I do 30 in the morning and another 30 in the evening (bend backward over a counter, hold for two beats). I use a reacher/grabber to pick things up off the floor. I strongly advise you to get full spinal X-rays and an MRI. Good luck!
Prednisone works great to relieve the pain but doesn't help that much to prevent the damage. PMR was a blessing to me because I could take Prednisone every day. Then Prednisone was the bane of my existence when I could never taper off Prednisone.
We should compare MRI results because we have a lot in common.
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Fortunately, I finally got off Prednisone 15 years after the onset of PMR.
I was diagnosed with spinal arthritis in June 2023, followed shortly thereafter by advanced OA in both shoulders and one knee. PMR followed in January 2024. You are so right about prednisone masking the pain. Now that I am down to 6.5 mg, everything is starting to hurt again. Tylenol gets me through each taper. Methotrexate seems to be helping. My first rheumatologist, who has since retired, told me early on that I needed to learn to distinguish between OA shoulder pain and PMR pain. Easier said than done. Earlier in my taper, I went up and down, up and down, because I was sure I was flaring. Now I tough it out and have been steadily decreasing by a half mg at a time. Facing full-blown osteoarthritis is daunting, but I know I MUST get off prednisone.
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