Is this common?

Your dose of prednisone may be too low, assuming that your diagnosis is correct. Usual starting doses are 15 mg or higher, even up to 30 mg and occasionally higher. If you can find a single dose once a day in the morning that will relieve all your symptoms, that will have a lower risk of prednisone side effects than split doses. If the starting dose does not relieve your symptoms adequately, it is likely that you will be in increased pain as you taper. Best to discuss this with your doctor and formulate a plan. Wish you the best and hope you become free of pain soon.

Hello @betsyhase, I saw your other discussion that mentioned you were recently diagnosed with PMR and started on 12 mg prednisone and you found out you had really bad pain the next morning and you have been trying to figure out how to split the dosage to help. I never really tried splitting the dosage but my starting dose was enough to quell the pain until the next mornings dose of prednisone. For both occurrences of my PMR, my starting dose was 20 mg. I think the average starting dose is 15 to 20 mg.

I wonder if the following discussions might be helpful:
-- Do I need a higher dose?: https://connect.mayoclinic.org/discussion/do-i-need-a-higher-dose/
-- How to Slowly and Safely Taper Off Prednisone but ... no set rules.
https://connect.mayoclinic.org/discussion/how-to-slowly-and-safely-taper-off-prednisone-but-no-set-rules/
You mentioned having brain fog. I didn't have brain fog with prednisone treatment of either of my PMR occurrences but I think it's something you should discuss with your doctor if you haven't already to see if there may be an alternative treatment.

@mark2471
Thank you

@johnbishop
Good idea. I am kind of overwhelmed with getting started on treatment. Since I started on a Friday night. I didn't have anyone to talk to. As I read more from this site you are probably right about starting too low on Prednisone.

After a year I am down to 5 1/2 mg. of Pred. in am. (Started at 20). I take 7.5mg of Meloxicam at bedtime. I've been feeling pretty good and thought I would try splitting the Prednisone - 3mg in am and 2.5 in evening eliminating the Meloxicam. Big mistake. I suffered through the entire next day with a terrible headache. (Not GCA) Went back to the other doses the next day and was back to normal almost immediately.

@kathleendw my doctor warned me off all NSAIDs while taking pred because of potentially worse side effects. But they do help with pain, and a higher dose of pred by itself is likely needed without them. I now sometimes use the NSAID gel rubs for localised intense pain, but that's all.

@gmdb My dr warned me, too. Said to take them as far apart as possible so I take the Meloxicam 12-13 hrs later. It prevents the elbow, wrist and hand pain I used to have for about 6 hours after getting up without increasing Prednisone.
Sadly, the gels don't work for me. So far, so good.

@betsyhase Hi. I can certainly relate to the brain fog and the weakness, along with the hip, knee, and shoulder pain.
I was started on 40mg of Prednisone, split by taking 20 mg in the morning and 20 mg at night. The pain vanished almost immediately (less than 36 hours.) I couldn’t sleep though, and that went on for a week, so I was prescribed sleeping pills. That helped get me six hours of sleep at night, but when I reduced my Prednisine at night to 10mg at night (30mg/day) that helped.
Now, 90 days since my diagnosis, I take no Prednidone at night, I sleep without sleeping pills, and I sleep 8 hours.
I’m down to 15mg/day now.
About half of the time, I have headaches during the night and especially before waking (getting out of bed) in the morning. Once I get up, the headaches fade away. Coffee helps, and I limit myself to one large cup/day.
I also have had pain (like razor blades) in the palms of my hands and the soles of my feet but but it is getting better. Numbness started in my hands and feet after starting Prednisone. My PCP says that is a Prednisone side/effect. He passed me in to a rheumatologist after the Prednisone (I’m convinced and so is my rheumatologist) triggered a blood clot in my leg and had to be hospitalized. Was I started on too much Prednisone , I don’t know but I’m taking far less now.
As you’ve probably figured out, other than pain and Prednisone, nothing is really the same for everybody.
I’m not a doctor but I’m going to suggest that you talk with or message your doctor about increasing your dosage of Prednisone just a little bit. I would try adding 5mg more per day and see if that eliminates your pain. Don’t over do it. Don’t under do it. Find what works for you then stick with that until your doctor and you agree to reduce the daily amount. Prednisone should eliminate your pain in a few days tops (less than a week.) That’s common with PMR.
If you split your daily amount into am and pm, most of the success that I’ve read about and personally experienced, advise to take most of it in the morning when pain seems to be the most and a lessor amount in the evening so you can still sleep.
Good luck and wishing you success in getting past PMR.
This is a wonderful support group and I’ve learned a lot from many here. You’re not alone.
Keep us up to date and informed on how you’re doing.

@stonewheel
This was a very helpful response. I have been adjusting my Prednisone and now seem ok on 10 mg in AM and 5 mg after dinner. Pain is now minimal and my brain fog gone. My MD is on board. Rheumatologist not available for 4-6 months but my primary is working with me and is receptive to my feedback of adjustments.
I guess I need to be doing a more careful diet of anti-inflammatory. I could be alittle better in that department.
Did you find your diet made a big difference?
TIA/ Betsy

@betsyhase my diet was great before PMR. I didn’t need to modify or change it.
This:
Vegan except raw fish (sushi) salmon and tuna for omega-3, lots of vegetables and fruit smoothies with anti-inflammatories like blueberries, strawberries, banana, kiwi, apple, aloe vera juice. Old fashioned rolled oats in the smoothie or cooked and add those fruits to break the breakfast monotony.
No dairy except cottage cheese, Parmesan and plain Greek yogurt.
salads
Moroccan ev olive oil, olive oil butter, only sour dough bread.
Local raw honey and 2 yard eggs every day.
Walnuts, pecans, and peanut butter.
Plant based burgers or chicken occasionally.
No sodas. No sugar. No sweets or candy.
Oat milk, coconut water, fruit juices, black coffee, and water ( 3 quarts a day, more in the summer.)
I know I rambled but that’s my diet.