Hi kathy i have had PMR for 4 years am now on 5mg pred -and still got pain but not as bad -and have been bad as you but i used to take paracetamol in bed about 7 am and it did hepl a bit with the morning pain and then i would take pred with my breakfast BUT then EILEEN gave me some good advice and she said to try to not take the paracetamol but instead take my pred very early in bed .SO I DID and i take my pred in bed at 5 am with a slice of brown bread and margarine washed down with warm drink from flask-then try to get back to sleep -and it hasmade a big difference to the amount of pain i am in on getting up ,not pain free of course but i hope you try it and find it helps you and any others reading tnis -good luck and let us know if it helps you .
One of the greatest problems we see among doctors is undertreatment with steroids. Remember, your goal is to restore normal tissue integrity as quickly as possible. Use steroids aggressively for the first few days until the inflammation is brought under control. Then, and only then, should you begin the tapering process. High doses of steroids over a short term of several days are almost always safe and effective. It is generally in protracted care (beyond three to four weeks of intensive therapy) where the risk of complications increases.
Variability in cortisol assays creates an additional problem with setting criteria for a normal response to ACTH that apply to all centers. Two studies comparing cortisol results obtained with different assays showed a positive bias of radioimmunoassays and immunofluorometric enzyme assays of 10 to 50 percent compared with a reference value obtained using isotope dilution gas chromatography-mass spectrometry. As a result, in one study, depending on the combination of assay and criterion used, between 0 and 100 percent of healthy volunteers would be considered to have a normal response to ACTH. This illustrates the difficulty of interpreting cortisol responses that are close to the cutoff point. (3)