failed reduction and neck pain

Hi, I can empathise with you over the neck/shoulder pain.  I have never gone back to what it was like when first diagnosed pre preds.  It could be you are a little impatient, and maybe at the same time trying to do too much (shifting snow?)?

I my humble option I have always waited till I knew I was ready to reduce even if it ment a delay before starting.  My motto is the story of the Tortoise and the Hare!

Best of luck - John

hi pparker , I'm so sorry to hear of your flare - again, but I have read that the reduction from 8 to 7.5 is a tricky one as 8/7.5 is the amount of cortesteriods our own body normally makes and at this level our own system is still not making any cortesteriods and so there is very little margin of error should our body be under any additional stress, could be the snow shovelling, and having to deal with the auto immune condition.

i had a flare in October of last year reducing from 9 to 8 and within 2 days of the reduction all the horrid PMR pains returned. I left it 2 weeks then upped my dose back up to 9mgs. Within a day the symtoms went away so I thought, great! I went to my rheumatologist and asked if I could reduce by a half instead of a whole gram. And he agreed. So I went home and the very next day, so I had only been on the upped dose of 9 for two weeks before I attempted to reduce again, even if it was only by a half. This time within 4 days all the pains returned and so I upped the dose back up to 10mgs in order that the prednisone could really control the inflamation which it did immediately. I stayed on 10mgs for 6 weeks and then reduced to 9.5 just 2.5 weeks ago. 

I'm telling you my story because I think you gave done exactly what I did wrong. You didn't stay on the increased dose of 8 long enough. This is the way I see it. If when you reduce you experience a flare that's telling you that the inflamation is still bubbling away so if that's the case the chances are there will not be much of a difference in the level of inflamation in 2 weeks. I think now, that if you have a flare get yourself back up to the dose you've just reduced from quickly and again stay on that dose for 6 more weeks then try again. I would stay on each dose for 4-6 weeks and simply reduce yourself down again, I don think there are any short cuts here.

in relation to the question of heat or ice. Well I cheat, if it's cold weather there ain't no way I'm gonna use ice so I use my shoulder heat pad and if the weather is warm then I use a ice pack!! There you go decision made for me!

as john has said it really is a case of the tortoise and the hare!

so stay on the current dose and reduce back down through the doses slowly and by .5 all the best pparker, christina

ppark, your "snow shovelling" will unfortunately aggravate those inflamed and steroid-weakened muscles.  Even worse, attempting any reduction whilst shovelling snow is not going to prove successful.

Did your neck pain improve whilst at  the higher doses?  If so, then perhaps an increase to 10mg would deal better with the pain than simply slightly increasing up in tiny amounts all the time.  You would then probably be able to reduce fairly quickly back down to where you last felt comfortable, ie 8mg.  Remain there for another few weeks, and then try reducing by half a mg on just a couple of days of the week, and then repeat, then gradually increasing the days at the new dose whilst decreasing the days at the old dose.  This slower tapering will help your body not to notice the steroid withdrawal.  BUT you will need to take things easy, especially whilst int he process of any reduction, so, if this is to succeed, you have to find someone else to shovel the snow.  The more physical work you do, the longer you will find you have to remain on any particular dose to cope with the inflammation.

You are also nearing the dose of steroid that matches the amount of natural steroid (cortisol) that our body makes when well - around 7.5mg - and your adrenal glands will have to start kicking in with their pre-steroid production again having been suppressed by the Pred.  Hence you will have a shortfall until your body catches up.

I found the best treatment for my neck pain was a large electric heat pad.  PMR muscles like warmth, definitely not ice.  For instance, I used to find my warm shower in the mornings eased my pain and stiffness.  The heat pad might also help with the scoliosis.