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Weaning off of prednisone & pain management
Polymyalgia Rheumatica (PMR) | Last Active: Apr 28 2:43pm | Replies (56)Comment receiving replies
Starting in October, initially on P20, my dose had to be adjusted to P30 to tame the PMR beast. I started tapering after 30 days at 5 per month, then 1 per month, now down to P7.
During my last rheumy visit in January, she said my inflammation markers were now normal, and we were no longer treating PMR. The goal is therefore to get off the prednisone as quickly and safely as possible, and to therefore continue the 1mg monthly taper. Also, that my wrist pains could be expected to continue, and that I could take Tylenol, NOT any NSAID due to the conflict with the prednisone.
During a routine cardiology visit in February, I happened to mention my ongoing wrist and thumb pain (which at that time was up to level 3 in the morning, but went away by 3PM). My cardiologist ordered a wrist Xray which did not disclose any sign of any of the arthritises. Also, my RA lab was normal. And so, the morning wrist pain remains an undiagnosed mystery which I will continue to willingly tolerate, especially as I recently increased my morning Tylenol to 1000mg which make me pain-free by 10AM. In any case, this morning pain is almost certainly NOT something that should be treated with an increased dose of prednisone. Unless it can be determined using testing that the pain is in fact or probably PMR, increasing the prednisone is probably not the correct solution for so many reasons, the main one being that it might make tapering to zero much more difficult without risking adrenal insufficiency.
My rheumy did give me permission to use OTC topical diclofenac 1% on my wrists if desired. Although diclofenac is an NSAID, if used topically only about 5% gets into your circulatory system and therefore does not create a problem with the concurrent prednisone as it would do if the diclofenac were taken orally in pill form. For the time being, I have decided that my current pain profile does not warrant experimenting with yet another drug.
Thought for the day: After being treated for PMR, returning pain is not always PMR, and should not be automatically treated with an increased dose of prednisone without testing and a doc agreeing.
Best of luck to everyone…this too shall pass !
Replies to "Starting in October, initially on P20, my dose had to be adjusted to P30 to tame..."
You make a great point; thanks for sharing. I had a thought about the wrist/thumb pain you mentioned and the morning onset. It reminded me of chronic wrist/thumb pain I have. An OT (occupational therapist) identified it as de Quervain’s. It’s a type of tendibopathy so it wouldn’t come up on an x-ray. It usually gets better as the day goes on and you move it more.
She said it’s common for wrist pain including this to flare up overnight or in the morning because of the position people sleep in. She has me wear a brace at night, the kind that softly prevents me from moving my thumb. I had trouble keeping it on at night so instead wore it during the day, and it calmed down.
Once it calmed down, she helped me with adaptations and exercises to strengthen my wrist and it’s better now.
It could be worth trying a brace overnight or seeing an OT if you’re interested but if it’s not a bother, as my therapists say, “It’s only a problem if it’s a problem to you,” which I kind of liked.
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"Thought for the day: After being treated for PMR, returning pain is not always PMR, and should not be automatically treated with an increased dose of prednisone without testing and a doc agreeing."
Your comment above is a good point.
The same is also true during treatment for PMR. Prednisone will relieve many types of inflammatory pain. Just because the pain responds to Prednisone ... that doesn't mean it is PMR. There might be other options available to relieve non-PMR pain rather than taking Prednisone longer than is necessary.