upper back pain middle of back

[sagil]

I have had RA for 1 year now. I am on methotrexate, leucovorin, and prednisone. Could the pain I am experiencing mainly in am after getting up til about noon, be from my meds or my condition? It is located in the middle of my upper back. Any advise I am visiting my rheumy this Fri. Thanks as always.

[carolanivey]

Ah. Did you receive treatment and physical therapy after your accident? Were x-rays taken of your spine at the time? If so, maybe a follow-up x-ray is in order to see if anything has changed since then. Maybe nothing showed up at the time of the accident, but post-accident pain changed the way you walk, sit, stand, lie down, etc., which over time can reveal injuries that were hidden before, or have been brought into the light of day with prednisone use.

A referral to a physical therapist and/or pain management specialist may be in order. They'll give you exercises to improve your muscle tone in your upper back, which will hopefully help with the pain. You could be having muscle spasms in the area as a result of the accident. A pain management therapist can find these "trigger points" and inject them with a mix of lidocaine and cortisone to decrease inflammation and relax the muscle. They may send you home with pain patches, as well, and discuss how you can adjust your work station set up at your job to keep from aggravating the area.

That's good that you're below 5 mg on the prednisone - hopefully you can continue to wean off, but at 3 mg the long-term side effects are not as much of a concern. :) Weaning off can wreak havoc on your sleep pattern, though, which can make your pain worse temporarily. Hang in there!

[sagil]

I have been on prednisone since Oct. 09. I have decreased down from 10 mg. to 3 mg currently. I will suggest a bone density if this continues to be a problem. I was in a car accident in Aug of 08 and the left shoulder and upper back still get chronically sore.

[carolanivey]

What is termed "morning stiffness" is extremely common in RA patients. That it is occurring in only one area of your body suggests that it could be the position you're sleeping in at night, or you need a mattress with better support for your back.

How long have you been taking prednisone? Long-term use (or even repeated short "bursts" over a long period of time)  can lead to bone thinning which often manifests itself first in microfractures of the spinal vertebrae. If you've been on it for more than a few months and have not received a dexa scan (bone density test), ask for one. Have your height measured at every appointment to make sure your spine isn't collapsing.

Dexa scans are painless and don't take much time. They will scan two areas - your hips and your spine. (I've had my hips replaced, so they do my wrist and my spine). If your density is found to be slightly below normal (osteopenia), a prescription for something like Fosamax will rebuild it to normal.

Make sure you are getting plenty of calcium with vitamin D in your diet and supplements. Try to wean off prednisone, if you can. IMO, the long-term side effects - there are many, not just bone thinning - are not worth it.