1. < Polymyalgia Rheumatica (PMR)
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Anyone not able to get 24 hr pain relief from Prednisone?

Posted by nlcarl @nlcarl, Sep 16 4:24pm

I’m on day 17 of prednisone for newly diagnosed PMR. Within a few hours of that first dose went from level 8 pain to a 2.

Unfortunately pain always comes back around 3am. After 8 days of that, rheumatologist upped dose from 20mg to 30mg. Pain still comes back, but at a level 4 instead of 7.

I’m stuck. I’ve tried dose splitting and dose timing changes. The pain still comes back early morning.

Can’t begin tapering until it’s under control. Doc has called me in next week to discuss options - assuming Methotrexate or biological.?

Did any of you have this happen? Not able to put PMR “to sleep” for 24 hours with prednisone? Would love to hear some encouraging scenarios.

Haven’t gone back to ugly crying yet, but my shoulders, arms, clavicles and wrists/thumbs hurt so bad in morning I get the self-squeeze-out tears from the pain.
Grateful the hip/glutes/thigh girdle area has for some reason become less painful.

Interested in more discussions like this? Go to the Polymyalgia Rheumatica (PMR) Support Group.

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kjoed53 | @kjoed53 | Sep 23 10:06am
In reply to @mrsschib "@kjoed53 In my experience, YES" + (show)
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@kjoed53
In my experience, YES

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@mrsschib
I'm sorry you have written off so many doctors

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stubwolf11 | @stubwolf11 | Sep 24 11:09am

I’m having the same problem. I tapered down to 5mg about a year ago. Every thing was fine until a few months ago and I also wake at around 2am with pain level 8 to 10. My rheumatologist and I don’t want to increase my prednisone and I can’t take Tylenol or nsaids because of liver conditions, so he suggested trying Leflunomide which has some terrible side effects. Has anyone tried that medication?

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fredinwoking | @fredinwoking | Sep 25 11:58am
In reply to @jandee "Diagnosed in March of 2025. 15mg of Prednisone controlled symptoms, but never for 24 hours. At..." + (show)
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Diagnosed in March of 2025. 15mg of Prednisone controlled symptoms, but never for 24 hours. At 15mg, pain relief lasted 16bhours max, and as you say, always came roaring back by 2 or 3 am. Mornings were brutal. I have pain from hands through arms, shoulders and neck (also osteo in both knees, somewhat muted with pred). I have tapered three times, most recently to zero. My rheumatologist added methotrexate 6 months ago. No side effects except fatigue, but no obvious benefits either. Now off Prednisone for a month and trying to make do with two Tylenol Arthritis tablets daily and a lot of naps and self pity. Can't do much. Like most, I was active and healthy before PMR. I'm 78 and had hoped to continue enjoying whatever time I have left. PMR is a definite obstacle. 18 months of Prednisone caused - that I know of - cataracts a sharp drop in bone density, and weight gain. Have a follow up appt. next week and will ask if there are realistic options, effective, safe and affordable, or if it's just me and the pain and the Tylenol for the duration. Ugh

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@jandee
Male 81 - PMR diagnosed this June. Currently tapered to 12.5 mg Prednisolone. Tylenol (or paracetamol in UK) helps with other aches and pains (osteo arthritis).
For PMR pain I found a split dose helps (currently 5 mg at supper time ca 8pm and main dose 7.5 mg at breakfast ca 8 am). I wake up about 4 am with my brain buzzing, but eventually drop off and catch up with a siesta.
Regarding reduced bone density you could ask about alendronic acid. I am awaiting results of DEXA bone scan but expect it to be OK for now, although I a month ago I did suffer a closed L1 fracture after a high impact fall from a ladder rescuing our cat. Life is rarely smooth!

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jandee | @jandee | Sep 25 12:53pm
In reply to @fredinwoking "@jandee Male 81 - PMR diagnosed this June. Currently tapered to 12.5 mg Prednisolone. Tylenol (or..." + (show)
Profile picture for fredinwoking @fredinwoking

@jandee
Male 81 - PMR diagnosed this June. Currently tapered to 12.5 mg Prednisolone. Tylenol (or paracetamol in UK) helps with other aches and pains (osteo arthritis).
For PMR pain I found a split dose helps (currently 5 mg at supper time ca 8pm and main dose 7.5 mg at breakfast ca 8 am). I wake up about 4 am with my brain buzzing, but eventually drop off and catch up with a siesta.
Regarding reduced bone density you could ask about alendronic acid. I am awaiting results of DEXA bone scan but expect it to be OK for now, although I a month ago I did suffer a closed L1 fracture after a high impact fall from a ladder rescuing our cat. Life is rarely smooth!

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Thanks! I will ask about alendronic acid. New one for me. I guess we all wake up with aches in the early a.m. Kudos to you for rescuing the cat! @fredinwoking

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