Prednisone is used to treat many diseases and one of them is PMR (polymyalgia rheumatica). After watching my video interview of another Prednisone Warrior, this anonymous PMR patient felt inspired to share how she found balance between relieving the pain of PMR and successfully tapering. This article is part of a series of stories of Prednisone Warriors sharing their experience with prednisone side effects.

PMR Prednisone Taper

Hi Megan…

I was diagnosed with PMR in May of this year and was happy to find your posts. I was very interested in Diane’s story about her long journey tapering off prednisone for PMR. It sounds like she really continued to suffer with some pain (either PMR or steroid withdrawal) throughout her tapering. I wonder when she took her prednisone dose.

Like Diane, my morning pain & stiffness came on very suddenly (overnight). I am 69, of European descent, female, upper torso morning pain/stiffness got to the point where I dreaded going to bed at night because I knew I would start to stiffen up overnight and experience the morning pain and not be able to move.

I suffered for many weeks with my husband helping me to get out of bed before a very astute physician knew exactly what it was! Started at 10mg prednisone then was up to 15mg two weeks later and that controlled my pain.

During those 2 weeks, I tried various dosing times – initially at breakfast as recommended but the pain started returning by bedtime and then the breakfast dose took a while to give some relief.   The typical dosing with prednisone does not take into account the morning pain with PMR.

Dosing at night helped me go to bed without pain so it didn’t build up overnight and completely stopped the morning pain, but I didn’t sleep.

Circadian Rhythm for Tapering

After doing a lot of online research of medical reports, I found several studies/articles talking about the circadian rhythm. Suggesting dosing in the middle of the night for PMR specifically because of the morning pain.

“The body normally produces cortisol between 2 and 3 am which can then counter the cytokines that are produced between 4 and 4:30 am. One study compared dosing at 2 am vs 6:30 am and found there was much less morning pain with the 2 am dose. “

How She Did It!

That worked well, but I would start again with some shoulder pain at supper time because the early morning dose had worn off.

Doing a split dose (as suggested in a PMR forum) was my answer..10mg at 2 am and 5mg at 6 pm.  I could sleep well until my dose, had a tolerable amount of sleep disturbance after that, and awakened with NO PAIN.

After one month at 15mg and finally seeing a rheumatologist. He started my tapering – by 2.5mg every 2 weeks until I hit 10mg, then by 1mg monthly. I gradually reduced both splits until I was down to 8mg in a single dose at 2am. Even 2:30 or 3am was okay, giving me better sleep for a bit longer each night. Like Diane, I found I had to listen to my body.

I needed to go down very gradually (.5mg) the first week of each month. Then could finish the month at the desired target dose. This last taper to 6mg was further complicated by the time change, but I have been okay now finishing the month.
Each month now will be a new experience!

–Anonymous

Tapering off Prednisone

From Dr. Megan:

Tapering off prednisone for any condition is vital. Work closely with your doctor and follow medical advice from your providers. But often they will defer to you, as you know what your body is going through.

Tapering is as much an art as a science, so be sure to inform your doctor of how you feel.

If you need a taper chart to jump-start the structure you could use while tapering, I created the Ultimate Taper Chart, with all the options I’ve found. You can use this as a guideline on your tapering journey.

You may get it for FREE by filling out the form below.