How to address PMR pain while decreasing prednisone

I KNOW WHAT YOU MEAN WITH BEING PARALYZED WITH THE PAIN ACROSS MY SHOULDERS AND HIP GIRDLE, I COULD NOT MOVE OUT OF BED BUT WHEN THEY PUT ME ON THE PRED THE PAIN LEFT. THANK GOODNESS I HAVE HAD NONE SINCE THAT TIME BUT PROBABLY WILL SINCE I AM IN THE TAPER DOWN STAGE NOW. WITH ALL THE CRAZY STUFF THAT IS GOING ON IN THE WORLD IT IS WHAT IT IS SO I WILL DEAL WITH IT! I JUST WANT TO GET MY SENSE OF SMELL AND TASTE BACK NOW SO I CAN ENJOY MY FOOD!!

I was finally diagnosed with PMR on April 1st of this year after being passed to 5 different doctors. First my oncologist, then he passed me to my GP who passed me to the radiologist then to the neurologist (who actually diagnosed PMR) who sent me to the rheumatologist. I started symptoms of PMR at the end of January. Each doctor did blood work but no one picked up on the very high C Reactive Protein count. I had just finished my breast cancer treatments in December and have neuropathy from the chemo treatments so think the doctors were more focused on that than anything else. Anyway, I have been put on Prednisone 10 mgs and was given a butt shot (not sure for what, maybe cortisone) at the first visit. The symptoms went away immediately from not being ab le to get out of bed without a lot of pain in arms, shoulders, legs, hips, etc. to being completely pain free. I was advised to drop a mg every two weeks so am now down to 7 mgs in a few days. So far so good. I was overweight and have lost 60 lbs since chemo which is a little too much, but since Prednisone have now started to gain a little more. I really appreciate this board as I'm learning things that were not mentioned by the doctor. I'm eating right, sleeping well, but have a hard time doing a lot of exercising as I get so fatigued so fast. Does fatigue go along with the Prednisone?

Fatigue is one of the components of PMR. I have been dealing with PMR for over three years. I am one of the unfortunates who has not gone into remission. I am currently taking 7.5 mgs of prednisone daily and am titrating at .5 mg per month. I am still hoping for remission.

Hello, Pauletta@rachelp, I really have to agree with you that fatigue is huge when you have PMR. I was diagnosed in Oct’18 and still can’t get rid of it! Was on 25 mgms Prednisone and finally, got down to 1.5...then it raised its ugly head again and I’m now back on 10 mgms. It’s in my hands and wrists as well as shoulders. Yes, still hoping for remission...or more energy! John has been very helpful, giving advice on what to read, etc. It appears that not too many people know about PMR and that makes this MC blog so very helpful. Good luck with your remission.

In reading this thread of reports, it dawned on me that it might be good to restate some of the “rules” for dealing with PMR. I put that in quotation marks BECAUSE RULE NO.1 IS THAT THERE ARE NO RULES THAT APPLY TO ALL PMR CASES. Everyone is different, but there are similarities that I have learned in my 2 years of dealing with, and researching PMR. I am not a doctor, but will share what I have learned from this forum and another larger forum in the UK.
RULE 2. Blood tests don’t always correlate with clinical symptoms. I have never had any abnormal blood tests, certainly not a hint of inflammation. That’s not unusual. Sometimes PMR will produce markers (sedimentation rate or other indication of inflammation), but up to 20% of patients never have any. A PMR diagnosis cannot be made on the basis of blood tests alone. Period.
RULE 3. PRM pain is most often in the shoulders and hips, but can appear in many other places. The key is that it is almost always bilateral, that is on both sides of your body at the same time. An injury or arthritis usually will be on one side or the other.
RULE 4. The best indication of PMR is an almost immediate relief from Prednisone (can be within an hour or up to a couple of days). Prednisone alone will not affect or cure arthritic pain or an injured muscle.
RULE 5. The disease sets the rules of tapering. Every case is different, especially in response to medication. You cannot “preset” a tapering schedule from a book. I began on 40 mg of Prednisone, a friend on 50. The Europeans do not recommend anything over 30 unless you have GCA. The point is to knock out the pain and then taper SLOWLY until it returns. I went a year in gradual taper until I hit a relapse at 3 mg. Bumped back up to 10, now am back to 2 mg and am doing well. I am lucky. Many of us never get off Pred, and many require years. It does appear that the ones with the most success taper very slowly and deal with the effects of Pred rather that the pain of PMR. Dropping by half a mg once you are inside ten mg per day should be considered. Precipitous drops from, say 10 to 5, often do not work. Again the goal is to take the lowest dose that controls the disease.
RULE 6. PMR is not well known to many doctors. It’s not rare, but unless you’re in the hands of a good rheumatologist your doctor may be unfamiliar with all of the variables involved with PMR. (The Mayo website is a good place for them to start).

I hope this is helpful to readers. I can supply a link to a website dealing with “slow tapering” if anyone wants it. See healthunlocked.com/Pmrgcauk or steroidtaper.azurewebsites or steroidtaper.com.

In reading this thread of reports, it dawned on me that it might be good to restate some of the “rules” for dealing with PMR. I put that in quotation marks BECAUSE RULE NO.1 IS THAT THERE ARE NO RULES THAT APPLY TO ALL PMR CASES. Everyone is different, but there are similarities that I have learned in my 2 years of dealing with, and researching PMR. I am not a doctor, but will share what I have learned from this forum and another larger forum in the UK.
RULE 2. Blood tests don’t always correlate with clinical symptoms. I have never had any abnormal blood tests, certainly not a hint of inflammation. That’s not unusual. Sometimes PMR will produce markers (sedimentation rate or other indication of inflammation), but up to 20% of patients never have any. A PMR diagnosis cannot be made on the basis of blood tests alone. Period.
RULE 3. PRM pain is most often in the shoulders and hips, but can appear in many other places. The key is that it is almost always bilateral, that is on both sides of your body at the same time. An injury or arthritis usually will be on one side or the other.
RULE 4. The best indication of PMR is an almost immediate relief from Prednisone (can be within an hour or up to a couple of days). Prednisone alone will not affect or cure arthritic pain or an injured muscle.
RULE 5. The disease sets the rules of tapering. Every case is different, especially in response to medication. You cannot “preset” a tapering schedule from a book. I began on 40 mg of Prednisone, a friend on 50. The Europeans do not recommend anything over 30 unless you have GCA. The point is to knock out the pain and then taper SLOWLY until it returns. I went a year in gradual taper until I hit a relapse at 3 mg. Bumped back up to 10, now am back to 2 mg and am doing well. I am lucky. Many of us never get off Pred, and many require years. It does appear that the ones with the most success taper very slowly and deal with the effects of Pred rather that the pain of PMR. Dropping by half a mg once you are inside ten mg per day should be considered. Precipitous drops from, say 10 to 5, often do not work. Again the goal is to take the lowest dose that controls the disease.
RULE 6. PMR is not well known to many doctors. It’s not rare, but unless you’re in the hands of a good rheumatologist your doctor may be unfamiliar with all of the variables involved with PMR. (The Mayo website is a good place for them to start).

I hope this is helpful to readers. I can supply a link to a website dealing with “slow tapering” if anyone wants it. See healthunlocked.com/Pmrgcauk or steroidtaper.azurewebsites or steroidtaper.com.

Re. Rule 3...I am currently tapering and had to increase from 7 to 10 mgs. due to increased discomfort (below waist and above knees) and especially pain in my thighs, but honestly it's primarily in my left thigh. I don't believe it can be anything other than my PMR (such as a strain), but I'm concerned now based on your comment about it being bilateral. Comments?

Re. Rule 3...I am currently tapering and had to increase from 7 to 10 mgs. due to increased discomfort (below waist and above knees) and especially pain in my thighs, but honestly it's primarily in my left thigh. I don't believe it can be anything other than my PMR (such as a strain), but I'm concerned now based on your comment about it being bilateral. Comments?

In reading this thread of reports, it dawned on me that it might be good to restate some of the “rules” for dealing with PMR. I put that in quotation marks BECAUSE RULE NO.1 IS THAT THERE ARE NO RULES THAT APPLY TO ALL PMR CASES. Everyone is different, but there are similarities that I have learned in my 2 years of dealing with, and researching PMR. I am not a doctor, but will share what I have learned from this forum and another larger forum in the UK.
RULE 2. Blood tests don’t always correlate with clinical symptoms. I have never had any abnormal blood tests, certainly not a hint of inflammation. That’s not unusual. Sometimes PMR will produce markers (sedimentation rate or other indication of inflammation), but up to 20% of patients never have any. A PMR diagnosis cannot be made on the basis of blood tests alone. Period.
RULE 3. PRM pain is most often in the shoulders and hips, but can appear in many other places. The key is that it is almost always bilateral, that is on both sides of your body at the same time. An injury or arthritis usually will be on one side or the other.
RULE 4. The best indication of PMR is an almost immediate relief from Prednisone (can be within an hour or up to a couple of days). Prednisone alone will not affect or cure arthritic pain or an injured muscle.
RULE 5. The disease sets the rules of tapering. Every case is different, especially in response to medication. You cannot “preset” a tapering schedule from a book. I began on 40 mg of Prednisone, a friend on 50. The Europeans do not recommend anything over 30 unless you have GCA. The point is to knock out the pain and then taper SLOWLY until it returns. I went a year in gradual taper until I hit a relapse at 3 mg. Bumped back up to 10, now am back to 2 mg and am doing well. I am lucky. Many of us never get off Pred, and many require years. It does appear that the ones with the most success taper very slowly and deal with the effects of Pred rather that the pain of PMR. Dropping by half a mg once you are inside ten mg per day should be considered. Precipitous drops from, say 10 to 5, often do not work. Again the goal is to take the lowest dose that controls the disease.
RULE 6. PMR is not well known to many doctors. It’s not rare, but unless you’re in the hands of a good rheumatologist your doctor may be unfamiliar with all of the variables involved with PMR. (The Mayo website is a good place for them to start).

I hope this is helpful to readers. I can supply a link to a website dealing with “slow tapering” if anyone wants it. See healthunlocked.com/Pmrgcauk or steroidtaper.azurewebsites or steroidtaper.com.

Thanks for the information. I don't think it has been mentioned about the time limit on a certain mg. before stepping down a dose. For instance, I started on 10 mgs. and was told to step down after two weeks. I am now on 6 mgs and have had no trouble so far. Is this two week between mgs. the normal time or is it different with each person?