@pmrnew I went through the same struggle wondering what level of pain was acceptable in order to take as little prednisone as possible. I had a good friend go down the PMR road before me and her advice, along with my rheumatologist has been spot on.
The goal is to have no pain. To allow your body to have the inflammation and pain is doing it a disservice. Allowing the inflammation to foster and cause damage will only create more problems for you. For example, in order to get your pain under control, you’ll have to increase your prednisone dose even more, causing your taper to last longer.
In the beginning, you can do a quicker taper from a higher dosage without feeling as many side effects as when you get to a lower dose. It’s at the lower doses you’ll need to be more patient and take your taper slowly.
I started at 20 mg in January 2026 and I am currently at 7 mg tapering by 1 mg a month. Early on when I tried to taper more quickly, once I got to 7.5 mg I was having a lot of pain again. I went back up to 10 then back up to 12.5 before I was pain free. Once I got back down to 10 mg my doctor has me tapering 1 mg a month. So far it’s been going great. I don’t have pain.
I understand once you hit around 5 mg you might have some pain return, but that can be different as it may be your adrenal glands trying to wake up again. That has its own kind of discomfort and pain not to be confused with a PMR flare. Have patience when you start to get to the lower doses. Cut your pills in half if you must, or stay at a dose a little longer while your body is adjusting. Just go slow and it will be better for you in the end.
And lastly keep your body moving with any kind of exercise. It doesn’t have to be strenuous just consistent. It really helped me more than strict anti-inflammatory diets. I tried them and I found no difference for me. I eat a balanced healthy diet, except for spinach which I love but gets in the way of calcium absorption which we need for our bones when on prednisone.
I hope this helps. I wish you a pain free taper!
P.S. when I over do gardening or exercise I highly recommend the Tylenol Arthritis formula. It really helps.