I'm so sorry to hear this and completely sympathize with your situation. 40mg is definitely a higher dose, but it works, and I'm hoping to be able to step down soon. If 20mg isn't working for you, I agree with others that you should definitely try to see a new doctor/rheumatologist. From what I've learned, too many doctors are overly fixated on reducing steroid use at the expense of pain--and pain equals inflammation, so they're not actually treating the PMR if they don't eliminate the inflammation before starting a taper. The side effects are pretty miserable, but frankly I'd take them over the pain any day. Good luck to you and I hope you find relief soon.