Weaning off of prednisone & pain management

The Voltaren is an interesting topic. Even though it is a NSAID/Ibuprofen base, my Rheumatologist/P.A. instructed me to apply it to the pain areas four times per day. I reminded her that it was an NSAID and she replied' "It's on your skin". Isn't the skin the largest membrane of our body? I have applied it to my lower back area once or so daily, but not four times per day, but still conservative. I do really miss the Ibuprofen over the Acetaminophen for pain and irritation relief.

The following link spells it out. However, there is considerable controversy about what the "best way" actually is for weaning off prednisone while still managing the pain.
https://emedicine.medscape.com/article/330815-treatment
"Joint guidelines from the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) conditionally recommend starting corticosteroid therapy with 12.5-25 mg/day of prednisone or the equivalent. [30] A systematic examination of the peer-reviewed literature, which included 30 studies, found that most patients seemed to achieve remission of PMR with a starting dose of prednisone at 15 mg/day. A slow tapering of the prednisone, less than 1 mg/month, was associated with fewer relapses. Once prednisone is tapered to 10 mg/day, a further slow taper by 1 mg every 2 months until treatment discontinuation was associated with optimal control of disease activity. [43]"

From my personal experience of 12 years taking prednisone for PMR, there are no magic ways that work the best for everyone. There were some approaches that worked best for me personally.

I have decided there is no "best way" and you have to do "what works best for you." That doesn't mean to "self-medicate" and go it alone. I tried that too and it didn't work.

You need to work with your doctor until you find a way that works for both you and your doctor. Easier said than done! I gave my rheumatologist most of the credit but WE eventually found a way. I have been off prednisone for 2 years with minimal pain. I have mostly recovered from prednisone side effects.

The link above also provides some alternatives to long term prednisone when the recommendations don't work. I think you still need to give prednisone a year or two before the alternatives are tried. This time frame is usually followed unless you experience considerable side effects from prednisone earlier than some people.

Sometimes PMR isn't "self-limiting" like it is supposed to be. However, the side effects from long term prednisone use are well documented. In fact, any dose of less than 7.5 mg is extremely problematic and may also be a prednisone side effect acquired from long term use. This probably explains why you need to go slower when you reach single digits of prednisone.

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 !

I also have had a cholesterol problem, probably genetic from my dad. I tried a couple statins, thought they caused muscle contractions in my hand, so my pcp suggested zetia, 10 mg. I am splitting the tablets in half, my last cholesterol test was 170 so I feel okay that a minimal dose is working.

Hi- I was just wondering, are you still taking just half a tablet of Zetia and if so is it working for you?

We’re considering resuming a trial of it for my dad because it’s possible the diarrhea he experienced before may have been from something else and his numbers are still a bit risky so we’re reconsidering it. Thanks and hope you’re well!

When I was on prednisone, atorvastatin was started for total cholesterol readings over 300. When Prednisone was discontinued my total cholesterol was below normal when I stayed on the same dose of atorvastatin My atorvastatin dose was decreased to half of the lowest mg tablet available and my cholesterol level was still too low.

After atorvastatin was discontinued my total cholesterol was slightly higher than my endcrinologist wanted. He said I was "extremely sensitive" to atorvastatin after discontinuing prednisone and didn't want to restart another statin.

I'm now on 10 mg of Zetia which was started a few months ago. My cholesterol levels were finally in the middle of the normal ranges the last time they were checked. Zetia seems to work for me. However, I'm waiting for my cholesterol levels to be checked again to see which way they are trending.