Hello John, thank you for responding. when I flare up I usually have to increase to 8 or 10mg for pain relief. I reduce by 1mg monthly until 5mg then 1mg every 6 weeks or so until I reach 4mg. I then reduce by 1mg after two months then on 3mg for a further 2months then 2 1/2 and within a week or so I had a flare up.