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Conflict with Rheumatologist over taking Prednisone for PMR in AM/PM
Polymyalgia Rheumatica (PMR) | Last Active: Jul 29 2:54pm | Replies (29)Comment receiving replies
And that raises other questions.
1. If the natural cortisol level is highest early in the morning and cortisol is supposed to help with PMR pain, why is that the time that PMR pain is often worst?
2. Why are we told the best time is morning dosing when that extends the peak cortisol level well beyond the natural mid morning reduction? Does extending the peak cortisol time more effectively control inflammation, or...?
3. Since everyone's cortisol fluctuations are different, why do some doctors continue to push the one-size-fits-all regimen of one dose in the morning only, especially when altering that regimen would result in less pain and inflammation for some people?
I'm not expecting you to answer the questions, just posing them.
Replies to "And that raises other questions. 1. If the natural cortisol level is highest early in the..."
Your comments are exactly right. I think it must be pretty tough for the Dr to try and make a medication to fit. Thats why a DR - patient relationship is important. But its hard to get that anymore. I was able to take in the morning and sleep all night. I think lots of people on here are able to do that. However, there is a significant amount that cannot do that. Then they are searching for sleep medication. Before long your Dr is prescribing more medication. Sort of becomes like Michael Jackson. Prednisone , besides producing cortisol has an inflammation blocker. I think Brian1950 said his Dr was fine with splitting the dose. Dr said taking it all at night was not. Just my thoughts.
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I can hardly understand it from my own experience so no, I can't answer those questions.
From my own personal experience, my PMR pain and stiffness was the worst at 3 a.m. The pain woke me up so I took Prednisone at 3 a.m. I suspect my cortisol level was too low during the night.
I was still working and I needed to be at work at 7 a.m. I needed to make a decision at 3 a.m. about calling my employer to let them know if I was able to work or not. I could hardly move at 3 a.m. If I took Prednisone at 3 a.m., by the time 7 a',m. rolled around, I was ready to go to work at 7 a.m.
I doubt many doctors will tell their patients to take Prednisone at 3 a.m. However, they do say to take it when you wake up in the morning.
I only took a small portion of my Prednisone dose in the evening before going to bed. That was so I wouldn't wake up in pain at 3 a.m. I think it worked because my cortisol level wouldn't get so low during the night.
I did what I needed to do but that does not mean it will work for someone else. For the most part, my doctors didn't care when I took Prednisone as long as it was relieving the pain.
My doctors were only concerned about how much and how long I was taking Prednisone.