Reducing but feeling it!

[Sportsgirl]

I have reduced prednisone from 15 mg to 8 mg since May 2019. My last reduction from 9mg to 8 mg using the slow method has caused me some concerns. At the end of the reduction, I started feeling bottom pain and now some shoulder twinges. Any suggestions on what I should do would be appreciated.

[HeronNS]

This will be short because it's nearly midnight here and I should be hitting the hay. However I recommend you go back to 9 if you were good there and wait a couple of weeks. When you feel ready to taper again, go down by only .5 mg. That may work. I found I had to start doing this when I tapered from 10 to 9. I went back to 10 for a couple or three weeks then started a slow taper which worked very well for me until I hit my "lowest best dose" some months later (around 2 mg).

[Hidden]

Hi, even using dsns method I had to stop, go back and start again after symptoms rested. You are in a fun g place once dropping down single figure and 10% reduction aren't always possible. So agree with heron you need to go back, rest then do 0.5mh drops. I did this from 11mg to 6mg. Let us know if 9 works. 🌻

[Blearyeyed]

You may need to return to the previous dose if it is a warning of an increase in Flare activity , but I also noted your name.

As a Sportsgirl it may be a good idea to look at the level of physical activity and how busy you have been in general during this taper and try to assess wether the combination of the reduction with activity may have caused the Pain to return to.

You will know if you have flared before what the PMR activity feels like for you , try to assess if you think this is a PMR Flare or some other Pain.

You could be having non PMR pain or even some nerve pain like sciatica which may benefit from some more rest , gentle stretches to relieve the sciatic area and your muscles in general to help the shoulders and a few days on standard dose Paracetamol may bring you Pain Relief.

If that is the case , you may not need to return to the previous dose but could remain on 8 mg for the month and then possibly reduce by 0.5 mg per month instead after that , adjusting your plans and activities at the start of the taper to make it easier .

If you find the Pain continues or increases despite trying non PMR pain relief you can be more confident in a PMR Flare and return to the 9 mg , but try a smaller dose reduction next time around with more rest in your first week.

Take care and good luck

[Sportsgirl]

Thank you for your advice. As the aches and pains returned on the second half of my reduction to 8 mg, I am thinking it is more of a flare than being too active. I actually have been careful about my levels of activity making sure I have lots of rest but I will monitor it closely. I will be going back to 9 mg today.

Again, I appreciate your thoughtful suggestions and your time.

[PMRpro Ambassador]

Go back to 9mg and don't procrastinate.

You aren't reducing relentlessly to zero - you are looking for the lowest dose that manages the symptoms as well as the higher doses did. And that was probably 9mg. It doesn't mean it won't get lower, just not yet.

[Sportsgirl in reply to PMRpro]

I increased the prednisone to 9 mg and I did get some relief but looking back and being completely honest with my myself, I realized I was experiencing lots of niggles at 9 mg but not 10 mg. Should I go up to 10 mg and stay for awhile there then reduce by .5 mg in the slow method. I also have a rheumatologist who gave me naproxen to use if I experience aches when reducing. I tried them yesterday and found I had some relief in the buttocks and thighs but I knew there was something there.

What do you suggest? 1) up my prednisone 2) use both prednisone and naproxen. Also, how to I support my decision with the rheumatologist if I go with plan 1?

I appreciate all the input from the mentors. Where would we be without you. 👏

[PMRpro Ambassador in reply to Sportsgirl]

I personally wouldn't use Naproxen together with pred - I'd far rather take 1mg more pred! If it is reducing pain it should go with paracetamol and after a few days anyway. If Naproxen helps I'd doubt it is due to PMR myself.

Try both and see which works better and if you have to go to 10 it probably wouldn't be for long - then do the 1/2mg reduction and see how it does. And if he asks - say you had too much pain

[Sportsgirl in reply to PMRpro]

Thank you. So appreciated.

[Sportsgirl]

Lol. Love your push! I am on this and I thank you for you your directness!