Prednisone increase what is best time

[Anic]

Diagnosed with PMR in Dec 2020. Started 30mg Prednisone and with help of supplements came down to 2.5mg (not completely pain free) but was managing until 3weeks ago when sciatica came info picture. Horrible pain, cant sleep at night. GP said to up Prednisone To 5mg for a week to improve inflammation. I also started physio last week, which is helping but slow progress.

Physio said maybe up Prednisone by 1mg at night to see if it improves??

Which should i do? If any?

I could use the very helpful advice of this group.

[PMRpro Ambassador]

You could try the flare procedure: add 5mg to your current dose for up to 10 days and then you can drop straight back to the dose ABOVE where the flare happened.

Has the physio said what they think is causing it? I had similar problems last year, entirely due to spasmed muscles in my back but also part of a flare of the PMR. I was at nearly 20mg and it didn't help that part of it all. It has been physio and mobilisation of the spasmed muscles that has worked, not pred.

[Anic in reply to PMRpro]

thank you for your reply.

The problem started when i went to pickup shampoo in shower. That was slightly bearable. Then a week later i pucked up my 3 year old nephew to put him in his cot and that started the nerve pain nightmare🥲

The sciatic nerve is now inflamed and GP thinks upping 5mg will reduce inflammation.

Physio said that inflammation of sciatic nerve will also affect general inflamation levels. She knows I'm not quite happy to up Prednisone so maybe thats why she suggested the 1mg increase??

[PMRpro Ambassador in reply to Anic]

1mg is unlikely to achieve anything though you could try it. Try the flare procedure - you lose nothing and may gain a lot.

[Anic in reply to PMRpro]

is it worth splitting?? 2.5 morning and 2.5 at night?? Or just take the lot in morning which is my usual routine??

[PMRpro Ambassador in reply to Anic]

Splitting at this level and taking some at night bears the risk that the midnight level of steroid in the blood is too much to encourage adrenal function. If you haven't done it before - why start now?

[Anic in reply to PMRpro]

I havent done it before and i was worried about doing it. Thank you for your help, I will follow.

[piglette]

In my experience the only thing that has helped sciatica is physio.

[Anic in reply to piglette]

thank you. I will continue with physio and once it settles i hope to do some pulates and keep moving. All getting very expensive.

[piglette in reply to Anic]

Sciatica is horrible. A friend showed me some exercises that are supposed to work, but I am not sure I am fit enough!

[Anic in reply to piglette]

yes i understand. Take care.