Prednisone and Pain

I talked to a pharmacist today and she said it was ok to split the prednisone dose up. Just need to be careful that I don’t take it too late in the day. So I’m going to try my prednisone 10mg with breakfast and the other 5 mg four hours later. If that doesn’t work I will need to contact my Dr to see if I need a prednisone dose increase.

Thanks

I’ve been battling for 7 years. I get what you are saying and feeling. Only opioids and/or burst prednisone were effective in controlling my pain. ( my blood work has been normal also)
We all know opioids are a rabbit hole and burst prednisone is unhealthy. Quite a dilemma. Hangin in there.

I understand that prednisone lessens the inflammation in the bursae and thereby cuts down the pain we feel. No one suggests that it lessens the basic disease, however. The only effective attack on the underlying problem seems to be--for some, at least--adopting an anti-inflammation diet. I am just a month into PMR treatment with 20mg, and I certainly am going to follow the excellent diet tips in the forum. Still, wouldn't it be wonderful if medical researchers found a cause for PMR? Now that we are approaching 2% of population, maybe eventually more attention will be paid. In all the reading I've done of NIH documents, there are studies but no useful conclusions, mostly "It seems likely that...".

I think the pred does dial back the amount of cytokines that are released and so lessen the damage that inflamation can do. The trick would be to convince the body that inflamatory cytokines are not needed. That is what the diet helps with. With Crohn's, I can not tolerated the ruffage so I take MSM which helps and LDN which also lowers certain cytokines.

My Rheumatologist told me that if Prednisone didn't work, it isn't PMR

Just 6 weeks into prednisone, I am wondering about the relationship between PMR (the disorder) and prednisone. My understanding is that the function of the steroid is to decrease inflammation in the bursae and therefore lower pain and stiffness--but it was no cure for PMR. If the steroid does not affect the essence of the PMR, why are we able to taper down from the level that first gave us relief? Are our bodies gradually making the prednisone more efficient? This query occurred to me after I found I could not go to 15mg (from a month of 20mg--I'm a big person) without some pain, but 17 1/2 works as well as the 20mg now. I understand the need to taper very slowly--I'm just wondering why it works, and I can't find an explanation on the web.

Here's some info from Mayo Clinic that may explain why tapering slowly works...

"Prednisone is like cortisol, a hormone naturally made by your adrenal glands. If you take prednisone for more than a few weeks, your adrenal glands decrease cortisol production. A gradual reduction in prednisone dosage gives your adrenal glands time to resume their usual function."
-- Prednisone withdrawal: Why taper down slowly?
https://www.mayoclinic.org/prednisone-withdrawal/expert-answers/faq-20057923

Thanks, John. Your comments are always so clear and helpful. I do understand what happens when the taper reaches a low number--different, I guess, for different people--but at the higher levels (I am at 17.5) the taper seems to work, too, and I believe my adrenals are still fast asleep. I am fascinated by this stuff and recognize there is still so much we don't know.

Just an FYI in case you haven't seen or used this tool - Another good tool for learning and finding studies on medical research is Google Scholar - https://scholar.google.com/

I had a condition that was was called “prednisone responsive” but only if I took a high dose. I usually started with 60 mg followed by a fast taper over a month or two. I could only tolerate 60 mg for about a week so it was good that I could taper down quickly.

When PMR was diagnosed my symptoms didn’t respond well to the higher dose but my symptoms were “manageable” at 30 mg or so. That was my “stable starting dose” however inflammation was still present on 30 mg.

It took many years to get down to 10 mg and maintain that dose. By that time my adrenals were very suppressed and my cortisol level was low unless I took prednisone.

I think my adrenals were incapable of regulating any increased levels of inflammation whether it was caused by PMR or something else like an infection, or other forms of stress … emotional or physical. It all caused inflammatoy pain. Whether or not it was PMR was hard to know with any certainty.

I think it mostly depends on how quickly a person can taper off prednisone. That becomes harder and harder as time goes on because the body because dependent on the exogenous kind of cortisol.