Prednisone is a magic bullet. It is a powerful anti-inflammatory that can make people feel very, very much better in a short period of time. As little as two or three days.
But there are consequences. Side effects. For more about prednisone and its side effects read this.
I have been in pain now for longer than I can remember. Sometimes it is mild, and is just background noise. But not often. And it has never receded to mere discomfort.
And when I say ‘as long as I can remember’ I mean years. About three years I think. I’ve had RA for about five years…but in the beginning the pain did go away sometimes. Those were great days in a lot of ways. In other ways they just allowed me to indulge my love of denial.
The last three years have involved daily pain. The pain is always worse at night. I have moderate to severe RA. The last nine months have been on the severe end of the spectrum, in regards to pain. Every single day. This is why I am trying methotrexate again, even though I have experienced some pretty horrible side effects in the past.
Right now, the pain has gotten to the point where I can no longer cope. You have no idea how hard that is for me to admit. I am the most stubborn woman in the world. And I like to think I am tough. (And I’m right, damnit!). But years of ongoing pain, and months of very bad pain, have taken me to the edge of my ability to cope.
Depression is taking hold. Defeat is possible. Giving up? Not an option. So that leaves me to live in a narcotic pain killer haze (oxycodone) or go back onto prednisone. And stay there for a while. Long enough to get a break from the pain, and get my head back together. Dealing with chronic pain is a mental game.
So here are the upsides. Prednisone works. It works quickly. It reduces inflammation fast, so it reduces the pain associated with that inflammation. It gives you energy. Energy is not something that people with RA have in spades. Fatigue is the second most debilitating symptom of RA. Not tiredness. Utter exhaustion!
Awesome! Let’s do it!
Not so fast. There are side effects. This is what I have experienced in the past. First, the headache. It’s unpleasant. But it’s better than RA pain. There’s dizziness as well, and some nausea. But I feel so much better, less pain, less stiffness, more flexibility that this is worth it.
The improvement is easily measureable. Instead if lifting ultra light weights in my Power class, I can lift about a third more, comfortably. In my yoga class I can hold the poses longer and deeper, and I can stretch much further. And at the end of class, I still have some energy left over. I recover much quicker as well. I feel a lot closer to normal. It is incredibly seductive.
Insomnia starts to be a problem by about day 3. I’ll lie in bed for hours, waiting for sleep. Last night I only slept about 4 hours. This morning, however, my pain is still mild. When I’m not on prednisone, I’m often kept awake by the sheer pain of rheumatoid arthritis. Insomnia from prednisone beats pain keeping me awake all night.
I do feel heavy headed and dopey though. And a little confused. My memory is poor. I have to write everything down. (Yay for my ipad!) It’s a lot like the brain fog of RA, though…so maybe it’s not even the prednisone.
So now the question is how long to stay on prednisone. How long a pain holiday can I safely take? I’ve done many quick tapers, and they don’t end well. I get severe psychological symptoms – anxiety, depression. The depression becomes profound as the dose gets lower, and takes a week or two to lift. Prednisone can induce psychosis – and this has happened to me. It can also induce bi polar events, or ongoing bipolar disorder. It is a very serious drug.
So I will taper much slower this time.
Right now, though, it is making me feel a whole lot better. I’m functioning at about 75% of normal. My pain is about a 4. I am not exhausted anymore. I am having a pain holiday, and I desperately need it.
For now, prednisone is the lesser of evils. Stay tuned in the days or weeks to come to see when that equation starts to turn.