Is everyone worse in the morning as compared to evening

[Susquin]

In reading about PMR I read that others are worse in the morning, I am the opposite and am at my worst when I first go to bed, usually takes me an hour or two to get comfortable (as in the pain subsides) and then by morning I am usually pain free. This is how I am on prednisone, before being diagnosed I was in excruciating pain all night and in the morning, but would feel fractionally better through the day. Currently back up to 10 mg due to flare, had been down to 5 mg, but can connect the flare to food. For sure now I know that white bread and any kind of lunch meat can set me off.

[PMRpro Ambassador]

Have you ever tried splitting the dose? Taking the second part at about 2 hours before you expect the pain to return?

Otherwise - are they sure it is PMR?

[Susquin in reply to PMRpro]

That is what I am beginning to question. Although when I was first put on prednisone there was instant relief. Prior to that I had all the symptoms of pmr. It is only now when I get a flare that I question do I have pmr or something else. I hadn't thought of splitting the dose, may try that. Thanks for your response.

[Hidden in reply to Susquin]

Are there any other symptoms you have noticed?

[PMRpro Ambassador in reply to Susquin]

My query refers to the timing of your pain - early night pain improving when you get up is typical of somethng else but you would probably differentiate by splitting the dose - if the pain is just because the antiinflammatory effect of pred has worn off, splitting should sort that out as long as you are on enough in general. So that would be a place to start. And work from there.

[Rene20]

Yes always worse in the morning stiffness subsides during the day often after taking Ibuprofen and pain relief. Not taking oral prednisolone now had 2 steriod injections since August they wear off after 5/6 weeks. Have now started Methatrxate 2nd week coming up. Fingers crossed it will do the trick and reduce need for steriods.

[Summerrental]

Before I was put on Prednisone the excruciating pain would start in the evening, last all night & subside shortly after I started moving around in the morning. Would have no pain through out the day & then would start again in the evening. Since on pred. relatively pain free except when doing taper, I experience a few mild pains until my body acclimates to new dosage.

[PMRpro Ambassador in reply to Summerrental]

Same question for you - are they sure about the PMR diagnosis? What you describe really isn't typical of PMR but would be seen in a form of inflammatory arthritis. I had a friend who also got a PMR diagnosis and responded well to pred until she struggled to get the dose down. She went to a different rheumy who happened to pick up on a comment about night time pain and did some other tests - and it was this inflammatory arthritis which can appear with a polymyagic presentation. It responds to pred at a high enough dose but is much better treated with other drugs.

Do you get any pain relief with ibuprofen? It rarely works in PMR but often does help with this arthritis.

[Summerrental in reply to PMRpro]

No, pain relief with ibuprofen, aspirin as any other of the nsaids. Rheumy had me on Meloxicam, Sulindac, Celebrex, Flurbiprofen that did nothing for the excruciating pain. Prednisone worked like a miracle, was free of pain the first day I was put on Pred. Started at 20 mg, am now down to 7 1/2 mg.

[PMRpro Ambassador in reply to Summerrental]

Fair enough - what an unusual presentation.

[HeronNS]

Before I was diagnosed I was in pain all the time, from the time it took for me to get out of bed in painful stages, through the day when I couldn't turn my head enough to see out the back window of my car, or had to pause for a moment to recover whenever I stood up from a chair, to the evening when I struggled to carry on with my exercises and one time it took half an hour to get up from the floor. Since treatment, starting in 2015, I've felt much the same around the clock, usually with a few niggles (probably only osteoarthritis now) but since about the end of the second month on pred never completely and utterly painfree, unless I happen to have taken aspirin for another reason. But I am in my 70s now, don't think I can expect much improvement from here on.

[Boss302Fan]

Ahhh...let’s put aside the nighttime vs daytime question for a moment.

I’m not sure it’s a nighttime vs daytime thing but more of an activity / inactivity thing.

For example I usually get up around 8 am and go to bed between 1-3 am (ok, I usually fall asleep in the recliner watching TV and wake up and go to bed).

Before treatment, when the symptoms first start I had stiffness and pain when I first got out of bed which lessened to pretty much gone as I moved around. If I sat down for more than 10 mins (i.e., inactive) the stiffness and pain returned. The longer sat the worse it got. If was moving around doing a bunch of stuff, even through the evening to just before going to bed, I was fine.

So, now, I put out this question. Let’s say a person works a shift where they sleep from 8 am to 5 pm and are active in the evening. I wouldn’t be surprised if their pain was worse at 5 pm and not throughout the night when they are active. I also think the amount and/or intensity of muscle use during the period of activity is directly related to the intensity and pain felt upon attempting to get out of bed the next day.

[BonnyQuine]

Well, I'm GCA rather than PMR, though I think they overlap to some extent.

Before diagnosis in Nov '16, my symptoms, esp the extreme headache, were much worse in the morning.

40mg prednisolone worked like a miracle for pain relief, but did seem to 'wear off' a bit in the evenings. Then, to avoid the worst of pred side effects during the day, I stopped taking pred in the morning and instead take it at bedtime (around midnight).

Ever since then, I tend to be at my best in the morning. (Amazing for me!) Now down to 3.5mg pred, and this still applies.

Maybe worth trying?

NB: It's all relative. My best is still a bit achey and creaky, but I'm almost 73 now, with bursitis and some arthritis, and take no other painkillers. At the moment am on an upward trajectory. Give me another year and, at this rate, I'll be in good shape for 74! Fingers crossed.

[PMRpro Ambassador in reply to BonnyQuine]

I'll be round for the birthday

[BonnyQuine in reply to PMRpro]

Roll on the day!