FLARING PMR AND ARTHRITIS

I have been in a flare for about 3 weeks, level 8 on pain scale. My PMR is outrageous and I am getting sick and tired dealing with it. The Nurse Practitioner put me on a prednisone burst to see if the pain I was in constantly would get better, it did for the first 3 days at 60mg. I had lots of energy, I forgot what it felt like, I was in low pain levels around 4 with my arthritis joint pain , prednisone does not work for it only the PMR muscle inflammation and pain. So when I had to make the sudden drop in prednisone from 60 mg. down to 40mg for 3 days, my PMR was not having it and so I have been flaring with it and with my arthritis and persistent head and neck pain and insomnia , all through Thanksgiving week up to today so far . Went back to the Nurse Practitioner and her and my daughter both could not figure out why that happened, well duh, you don't drop the dose of prednisone that extreme, I knew that why not them? they are the ones educated not me. So I opted for 20mg. until I went back in. Well she was not having it and told me to drop down to 15mg for 3 days and then after that back to my regular 10mg. So now the past 3 mornings I can't move my arms, hubby has to massage my upper arms with Aspercreme and lidocane to get them loose enough to be able to get in my wheel chair. I am trying the new Aspercreme with the Lidocane and I must say even at my 8 pain levels , about 30 minutes after it is applied my pain levels ease up a bit and mobility is much improved. So the Nurse Practitioner put me on Tramadol up to 4x's a day but because it makes me itch terribly she prescribed Zyrtec and I am still having to take benadryl to keep from itching, not working so well, and it is not even touching the pain. Switching up on the muscle relaxers    , I don't think that it is working, when flaring nothing helps, I don't know how it all works at my normal pain levels .So I have an appointment with an orthopedic surgeon for my shoulders and the very large cyst on top of my right shoulder joint it is about the size of a baseball. Will be getting an MRI on that cyst as well.
Living with chronic pain and mobility issues with back and neck, both arms and legs is challenging to say the least. I did manage to put a small 2 foot Christmas tree up but any more decorations, well I am just not feeling it this year . Last year and this year Christmas will not have any gifts bought for anyone, last year we had no money coming in and this year a little improvement but that money is ear marked for bills. Well welcome to my life. In spite of all the pain and circumstances I am doing OK with the depression levels , I seem to be holding my own and not too down over it all, I just choose not to let it get me down, life is what it is and I know it could be worse so I ain't having it get me down, no way.
for what it is worth,
healing blessings
PATC

ADDICTION the proper use of this word .

Here is some information that people need to get straight about the difference between ADDICTION and NEED when it comes to prescriptions /medications.
To be addicted means you are taking a medication for other purposes for which it was prescribed and you think you need them especially if you are no longer suffering from the condition that you were prescribed these medications in the first place. If you are addicted to pain killers it is NOT because you are taking them for pain!
People like me who take prescription pain killers take them because if we did not take them ,our quality of life would be very low. My pain levels without medications would consistently be above 8 on my pain scale, while on pain medications it ranges from 5 to 7 unless I am in the midst of a flare, then nothing seems to help. This nasty stigma that is placed on Chronic pain sufferers has got to stop!!! I take multiple medications for various reasons not because I want to but if I did not I would be very sick and may stroke out. Medications for thyroid, high blood pressure, for diabetes , for stomach issues ,usually stemming from the medications. I am NOT ADDICTED to these medications but need them for health reason , for a better quality of life, I am not taking them for a thrill ride. The same goes for pain medications, I for the life of me can not understand why anyone would choose to take them for any other reasons but for pain. I really don't get it. I don't like how they make me feel head wise but for pain yes I will take them, it is a compromise on my part. But to tell someone they are an addict because they have to take pain medications for a relatively decent quality of life is SHAMEFUL , HARMFUL and people this has got to stop!
Yes there is a major problem with over prescribing of pain medications and especially the Opiates when other lesser pain medications would probably do the trick. That is the fault of Doctors and apparently they need to be educated to the proper use of pain medications and for the proper prescribing of them to the proper medical conditions.
I am not talking about short term prescribing of Opiates after a severe injury or trauma or for treatment after major surgery, those prescriptions should be limited to possibly a weeks worth at the most. But for people with long term Chronic conditions that will remain with the individual the rest of their lives , to prescribe the proper pain medications for these individual so that they can have some semblance of a quality of life, that my friend is NOT ADDICTION. Chronic pain is pain that has outlived it's usefulness. Acute pain is an adaptive beneficial response necessary for preservation of tissue integrity.

Chronic pain and addiction  here
Addiction is a primary chronic neurobiologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestation. It's characterized by 1 or more of the following behaviors: impaired control over drug use, compulsive use, continued use despite harm -- and I emphasize harm -- and cravings.
Physical dependence is not addiction. Physical dependence is a state of adaptation that is manifested by a drug-class-specific withdrawal syndrome that can be produced by abrupt cessation of the drug, decreasing dose of the drug, decreasing blood level of the drug, or the administration of an antagonist that blocks the action of the drug.
Physical dependence and addiction can coincide, but physical dependence does not equal addiction in all cases. Physical dependence is a neuropharmacologic phenomenon, a natural physiologic event, while addiction is both a neuropharmacologic phenomenon and a behavioral phenomenon.
Tolerance is not addiction. Tolerance is a state of adaptation in which exposure to the drug induces changes that result in diminution of 1 or more of the drug effects over time. Now key to this definition is all other conditions remaining constant. The bad side of this for your patient is that the disease, the cancer, or the syndrome has progressed; the pain has increased. That is disease progression, and therefore, it is appropriate to titrate the opioids up and the adjunctive medications to a higher dose to meet the increased pain. That is dealing specifically with the disease, the cancer, or the syndrome and applying your rational pharmacotherapy appropriately.
Let me ask, would you make your patients beg for beta blockers, digitalis, or insulin, because you would be afraid that you would make them insulin-addicted diabetics or something similar? No, you wouldn't do that. You would treat the patient with mutual trust and respect and properly prescribe the medicine. The key with pseudoaddiction is that with proper pain management, retrospectively, the patient's behavior normalizes. However, with the disease of addiction, in the genetically sensitive individual, behavior deteriorates with pain management. Again, you're looking to improve their quality of life.
Chronic Pain vs Addiction
Now what is the difference between somebody who is a pain patient and somebody with the disease of addiction? A pain patient is not out of control with their medications. Somebody with the disease of addiction by definition is out of control. In a pain patient, the medications improve quality of life. In somebody with a disease of addiction, the quality of life is obviously decreased. The pain patient will want to decrease the medications if side effects are present, while the patient with the disease of addiction is oblivious to side effects and wants the medicines to continue despite any side effects.
The pain patient is concerned about physical problems; the patient with the disease of addiction is in denial. The pain patient follows the agreement for the use of opioids that you set up before writing the first prescription; the patient with a disease of addition by definition is out of control, cannot follow or does not follow the agreement for the use of opioids. The pain patient frequently has medicines left over. The point that I'm making is that the relationship between doctor and patient is one of mutual trust and honesty; you have a responsibility, but the patient also has a responsibility.
For what it is worth,
PATC

  

LETS TALK CHRONIC PAIN

Pain such a subjective and personal subject. Most people are relatively healthy, have occasional headaches, may have stubbed their toe, have a tooth ache, get sore muscles by over doing it from time to time, but really nothing that changes your life to any extent other than slow down a bit till it subsides, but in most cases it does subside. I know ,that USED to be me.
Now lets talk Chronic Pain, this pain never ever goes away although the pain level may go up and down , it is ALWAYS there and hangs around like a dark gray stormy cloud raining on your life day in and day out and in most cases changes your life considerably. If you have a chronic illness or have chronic pain your life that you had is only but a memory. The life we have now is in some cases, waking night mares.

When I tell some one I have arthritis, people shrug their shoulders as if to say, hey everyone gets that with age, it is nothing.  But it is something, your bones are grinding into itself, pinching nerves, inflaming muscles, making movement and mobility a major problem. Lets say you get a pain in one small little joint , lets say a finger or a thumb, it is amazing how it affects your body as a whole. Think back when you got a paper cut, the initial pain was terrible and made you think about that poor finger with a little bitty cut on it, but it hurt ,damn it ! That is not the pain I am writing about here.
 Think back when you came down with the flu, lets say it was a bad one and your sick in bed or on the couch for a week, your body aches all over , your tired, your nauseated and you just want  to sleep until it goes away,and you do sleep all the time.  Well , welcome to my world, and many like me with chronic pain, only in most of us with chronic pain  that flu like feeling NEVER goes away, sleep does not come as often as it should, most of us are lucky to get 2 or 5 hours sleep at a time and many of us have less than that. Pain and movement causes so much discomfort, finding a comfortable position to sleep in is troublesome,if your lucky enough to find it, because you know that when you finally find that spot, you will PAY FOR IT IN THE MORNING , because your body did not move much while you slept and so upon waking you are unable to move without a lot of pain and discomfort and even when you want to move your body makes it so hard to do so. Pain is something that alienates you from your family, friends and the world for that matter, because for many of us you can not see the pain or illness, you can not see anything on ones body that would cause this kind of pain, invisible. People can't see your pain, they only can see your reaction but not the cause of the pain in most cases. People can not understand why you are not up and about like you use to be, most of the time they think you are making a big to do about nothing, that my friends is sometimes worse than the pain we experience. Not to have love ones understand,or even believe you,hell trying to get your Doctor on your side is a miracle in itself. I thankfully have family and friends that do believe me and understand and are on my side, thank God, but many of us who are in Chronic pain are alone in that pain, and that is a damn shame on all their famiy and friends who do this to them.
 In my case I have 3 different types of pain maybe more, and one pain medication does not work for all types. Vicodin does nothing for head aches, in fact may give you one, for me it may relieve pain for a few hours but only to knock it down a couple of notches on the pain scale, BUT lately any Opiates cause severe nausea and dizziness and not worth a hour or two of lowering the pain a notch or two, but any reduction is a blessing, Ibuprofen/Advil may work on 'normal' headaches, and mild pain of arthritis or sore muscles, but does nothing for moderate and severe arthritis pain and forget relieving nerve pain which in most cases nothing works for it .  Arthritis for some may be just a shoulder, or an elbow, may be your fingers, maybe the location is just one knee, or various spots on one's back, but for the most part just one or maybe 2 locations on your body you could say has a 'bit of arthritis ' in it. That can be tolerable at least in the early and mild stages of it, something an Advil or two will help, maybe an ice pack or heating pad now and again  and off you go, now consider most of your major joints affected with 'arthritis' , in my case , both knees, my left hip, both shoulders, my neck, upper, mid and lower back, these hurt 24/7 but at some times all my fingers get affected, sometimes my jaw, sometimes, my ankles and feet, my toes, they get on the band wagon every once in a while as if to say 'don't forget us'. And this chronic pain started in my early 40's this is not 'just' an old person's disease.  I am thankful most days I have maybe 2 areas that are having more pain that the other areas,say level 6-8, although the other areas are just turned down lower, what I call back ground noise at a level 3-4 pain, that is after any pain medication I have taken.  But for those days we with chronic pain call FLARES, all your achy normal spots get a fire in them and all areas reach crisis mode with pain levels 7-9 and this is after pain medication mind you. Thankfully those days are not constant and those days are not as often, but they happen sometimes on a weekly basis. Sometimes it is just a few of your joints in crisis mode, and for those flares your medication takes the edge off, but when the flares happen to all your troubled spots, then God help us on those days.
I have,so the doctor says Osteoarthritis in most of my joints, . HERE which is why I am now in a wheel chair , I am able to stand for a minute or two and take a number of steps but then I am unable to move my hip or leg to go any further.
I also have: PMR  HERE , which is the most insufferable pain I have yet to deal with, I have it in both my upper arms not including the arthritis in both shoulders. The pain will totally mess you up, and make you so dependent on others and unable to even move your upper arms for anything , pain level for this untreated is 8-9. Thank God for Prednisone which knocks its down a whole lot but then I have to contend with its major side effects.But I and most sufferers of PMR disagree with the so called Specialists on this disease, it effects even young adults, it does not go away , it only goes into remission if you are lucky and may come back many times after remission.
I also have:Peripheral Neuropathy  which cause carpel tunnel and shooting pain and numbness and needle burning feelings in arms and legs. HERE
I also have Scoliosis of lower lumbar HERE  caused by the results from my Legg Calve Perthes disease I had as a child,HERE that cause my left leg to be shorter causing my spine to twist which in turn causes my sciatica HERE.
Then we have my neck and spine that has bulging discs and Degenerative disc disease with bone spurs.HERE  Caused by all the above and working hard as a CNA lifting adults that in most cases were too heavy to lift.
I am so thankful that I have not had any surgeries on my poor body because of all this, but it is in my future. Many like me, have already had many surgeries, and in some cases only made it worse, and some are a lot better from the ordeal.
This is all to explain that when it comes to pain and chronic pain I know what I am talking about but wish I didn't. Most of us do not seek pity, just understanding and acknowledgement. I exist as do the millions that suffer chronic pain. If you know someone who suffers, be understanding and don't add more weight to their already burdened  body and mind. Chronic pain for the most part, and for most of us cause extreme fatigue because it wears you out to be in constant pain and we suffer from various stages of depression and grief for the life we once had. Be loving and supportive to those who have chronic illness and pain, don't add to our already burdened life.
Blessed be.

 Below is a handy pain level assessment guide that I use: