Pain till afternoon

[3dogsheidi]

I’ve been on Prednisone for five weeks, the last two weeks 15 mg. I’m probably at 70 % better. But still have the same symptoms, just less? When I take my dose in am, along with Tylenol, it’s until about 2 pm until I feel relief. Then I go to bed wake up around 3-4 then my legs start up again. Like a burning. Once I get up, it’s mostly in my hips and hamstrings. I do see my Rheumatologist this Tuesday. I’m almost positive it PMR, but the burning in my legs I question. Does it take that long for Prednisone to work and should more of the pain be gone?

[PMRpro Ambassador]

It only works quickly and fully if you are on a high enough dose - if you aren't on enough, you might as well not be on any. 15mg is the bottom end of the range of starting doses as agreed in the 2015 Recommendations where they say the starting dose should be the lowest effective dose in the range 12.5 to 25mg/day. Our experience is that even 1mg can be the difference between a good result and a poor one. In some people the antiinflammatory effect of pred may not last the full 24 hours and symptoms return before the next daily dose is due.

The daily batch of new inflammation starts up after the cytokines are shed in the body about 4am. The optimum time to take pred is actually 2am so it is present in the body at its peak at the same time the inflammation start up and it is immediately dealt with. But if you can't manage that, the sooner after 4am you take your pred, the less work it must do and the sooner and the better the result will be.

I think you probably need to be on at least 20mg and if taking more and sooner doesn't improve things, splitting the dose may help, taking about 2/3 in the morning and the rest sufficiently later to extend the effect to 24 hours. Often lunchtime or early afternoon is enough.

[piglette]

I started on 20mg and the magic happened in 15 hours 26 minutes!

[Meggsy]

I started on 15mg but had to go up to 25mg to gain a satisfactory result.

[3dogsheidi]

I am thinking I may need a higher dose as well. Just trying to decide if I should wait till I see the Rheumatologist Tuesday or just try a higher dose for a few days. When they do find the correct dose, how long will I be on that before dosing down? Thank you

[PMRpro Ambassador in reply to 3dogsheidi]

Once you are on the right dose you need to stay there for a couple of weeks at least until the symptoms are well under control. You only have 2 days which may not be long enough to see a difference but when you do see them do make a good argument for trying more before they decide this isn't PMR. Though you do say you have achieved 70% improvement - which is what they look for.

[3dogsheidi]

It sure seemed like 70%, but I still have almost the same symptoms in my groin, thigh area. My shoulders no pain. Plus I have the pre back pain now. I’m just grateful I can bend over and go up and down the stairs. I will keep that in mind when we meet. I have a ton of questions for him. I wonder if it is the Spinal Stenosis that my other Dr was discovering during this time, as most my pain was bilateral hip and below?

[PMRpro Ambassador in reply to 3dogsheidi]

Groin and thigh pain is very possibly greater trochanteric pain syndrome with iliopsoas involvement - not uncommon in PMR. That can take a few months to resolve on moderate dose oral pred. I had it, took a good 3 or 4 months to go away on 15mg.

[bruce1951vet]

I started at 15mg of prednisone 5 months ago. I am currently at 7mg. I felt full relief after 2 days on the 15mg. Since then I have had trouble tapering down at the 10mg to 9mg level, pain in both shoulders and legs. Maybe you need a higher dose to start off with?

[PMRnewbie2017]

As you are fairly new to all this I advocate taking your Pred as early as you can after 2am as PMRPro has suggested. It really is a game changer for many of us and research has shown that it can result in a lower dose being required to manage the daily outpouring of inflammation chemicals. But whatever time you settle on you should aim to keep to that rather than yo-yoing in order to maintain a consistent blood level of Pred. I don't want to complicate matters too much but some people metabolise Pred faster than others so it is possible to modify when and how to take the dose to counteract this. But as I said, it is early days for you and at the moment the most important thing is to get your optimal starting dose sorted out

[3dogsheidi]

Thank you everyone for your responses. I will take all this information with me when I see Dr. tomorrow. I have upped to 20 mg for the last two days, maybe a slight difference, not so sure, so I guess my next thing would be to try in early AM. The only concern I have to this is to eat something with it at two am. I like to fast and want to make sure I can back to sleep. I’ve aways had issues with sleep, Fibromyalgia.