Prednisone is a corticosteroid medication used to decrease inflammation. Though not a pain medication, it can help to relieve pain. It is commonly prescribed to treat rheumatoid arthritis (RA), gout, lupus, chronic lower back pain, and knee osteoarthritis.
Side effects of prednisone include mood changes, insomnia, acne, and weight gain. Prednisone should be taken with food to avoid an upset stomach.The medication is commonly prescribed in a higher starting dose that is slowly tapered down.
This article discusses prednisone for pain. It explains how prednisone works to relieve different types of pain and inflammation and what you need to know before taking prednisone.
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How Prednisone Stops Pain
Prednisone belongs to a group of drugs called synthetic glucocorticoids, also called corticosteroids. It stops pain by reducing inflammation. Inflammation is the immune system's response to infections and injuries.
Sometimes, the immune system misfires and attacks healthy tissue. This causes the pain and inflammation associated with autoimmune diseases like RA and lupus. Prednisone works to address this in a few ways.
Stops Pro-Inflammatory Cytokines
The first way prednisone works is by preventing the production of certain pro-inflammatory cytokines—proteins that serve as messengers between cells. The overproduction of pro-inflammatory cytokines is associated with a number of chronic inflammatory and autoimmune diseases.
Prednisone prevents the production of cytokines by binding to glucocorticoid receptors—types of cell molecules that receive and send signals in the body. This prevents these molecules from sending signals that pro-inflammatory cytokines should be created.
Promotes Anti-Inflammatory Cytokines
Prednisone activates the production of some anti-inflammatory cytokines and affects the actions of certain lymphocytes (white blood cells) called T-cells, which play a central role in the body’s immune response.
Manages Edema Response
It also acts to control how easily molecules are allowed to flow in and out of blood vessels. This reduces tissue edema—swelling caused by small blood vessels leaking fluid into tissues.
All of this works to quickly relieve the inflammation, pain, redness, and warmth experienced during an exacerbation of your symptoms.
When Is Prednisone Prescribed for Pain?
Prednisone is used to treat both acute and chronic pain. It is available as an injection, topical treatment, and oral medication. Prednisone prescribed for short-term pain relief of:
- Acute joint injuries
- Bursitis
- Chronic back, neck, and joint pain
- Cluster headaches
- Gout
- Lupus
- Osteoarthritis
- Post-joint replacement surgical pain
- Psoriatic arthritis
- Rheumatoid arthritis
- Tendonitis, tenosynovitis, and epicondylitis (tennis elbow)
Prednisone shots can be delivered into a muscle or joint (intra-articular) and used to relieve arthritis.
Prednisone for Autoimmune Flare-Ups
RA primarily causes pain, swelling, and stiffness in the joints. It is often a disease of ups and downs, with periods when symptoms become worse, known as flare-ups or flares. These can be unpredictable and debilitating.
Prednisone is prescribed as short-term pain relief during these periods of exacerbation and as a “bridge therapy” to provide relief while waiting for disease-modifying antirheumatic drugs (DMARDs) to kick in.DMARDs are the recommended first-line treatment for RA, but they are slow to work; you may not notice benefits for six to eight months after starting them.
Signs that you are experiencing a flare-up include a worsening of the following symptoms:
- Pain or aching in more than one joint
- Tenderness and swelling in more than one joint
- Stiffness in more than one joint
- The same symptoms on both sides of the body (such as in both hands or both knees)
In RA, these symptoms are commonly most severe in the early morning.
Can Exercise Ease an Autoimmune Flare?
You can help to reduce flare-up pain symptoms without medication through physical activity and by maintaining a healthy weight.
The Centers for Disease Control recommends getting at least 150 minutes of moderate physical activity each week, though make sure you choose activities that protect your joints, such as walking, bicycling, and swimming. For people who have excess weight, losing just 10 or 12 pounds can improve pain and function.
How to Take Prednisone for Pain
Prednisone is typically prescribed on a short-term basis, ranging from a few days to a few weeks. The dosing varies by condition, with larger starting doses that are gradually tapered down. The maximum daily dose of prednisone should not exceed 100 mg a day.
Autoimmune conditions, such as RA, PA, and lupus, are generally started with a dose of 10 milligrams (mg) to 20 mg per day and then maintained at levels of 5 mg/day or more. In severe cases, higher doses may be needed. The maximum dose of prednisone for autoimmune-related pain is 80 mg a day.
Gout is treated with a starting dose of 30 mg to 40 mg a day until symptoms improve, then gradually tapered down. Treatment usually begins to work within two to five days and can be tapered over seven to 21 days to prevent a recurrence.
The length of your treatment course will be made on an individual basis, but short-term pain therapy is normally around one to three weeks.
Prednisone is available in both immediate-release and delayed-release formulations, which are taken by mouth in the form of a tablet or liquid. It is usually taken with food.
When you take your dose and how often you take it will depend on your condition and how you respond to treatment. Prednisone is often taken in the morning to mimic your body's increase in steroid production, which occurs early in the day.
It is important to know that if you have been taking prednisone for a while, you should not discontinue treatment suddenly, as it can lead to severe withdrawal symptoms. This is because if you suddenly stop taking prednisone, this may leave your body with not enough natural steroids to function normally.
Your healthcare provider will outline for you if and how the drug needs to be tapered down to avoid problems with withdrawal.
Drug Interactions and Diet
Prednisone is known to have numerous drug interactions, so tell your healthcare provider what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take.
It also has specific side effects that your healthcare provider might recommend you combat by restricting your diet. These restrictions include reducing the amounts of salt, sugar, and calories you consume. Make sure you follow these instructions carefully.
Before You Take Prednisone for Pain
Oral corticosteroids, such as prednisone, impact your entire body, and side effects, ranging from mild to severe, are not uncommon.
The types of side effects you experience are likely to depend on the strength of the dose and how long you take it. As it works by dampening down your immune system, taking prednisone also means that you may be at higher risk of getting infections.
There are certain health conditions that pose more of a risk when taking prednisone. Be sure to tell your healthcare provider if you have any of the following:
- Mental illness
- Diabetes
- Eye infection or a history of eye infections
- Heart disease
- High blood pressure
- Intestinal disease
- Kidney disease
- Liver disease
- Myasthenia gravis
- Osteoporosis
- Seizures
- Threadworms (a type of worm that can live inside the body)
- Thyroid disease
- Tuberculosis (TB)
- Peptic ulcers
For people who are pregnant or may become pregnant, it is important to talk to your healthcare provider about the potential risks taking prednisone may pose. Taking prednisone during pregnancy has been linked to oral clefts, preterm birth, and low birth weight in infants, as well as preeclampsia and gestational diabetes in the person who is pregnant.
As well as decreasing your ability to fight infections, prednisone may also prevent you from developing symptoms that indicate you are getting an infection. It is recommended to take precautions such as staying away from people who are sick and washing your hands often while taking this drug.
Due to its impact on the immune system, you should not have any vaccinations without talking to your healthcare provider.
Prednisone and Children
Special consideration is needed when prednisone is given to children. Corticosteroids can lead to numerous side effects which may slow growth and development in children, including nutritional consequences and decreased new bone formation. Talk to your healthcare provider about these risks and any worries you might have about your child taking prednisone.
Side Effects
Some of the most frequently discussed side effects of corticosteroids, such as prednisone, include:
- Increased appetite
- Weight gain
- Hair growth
- Acne
- Gastrointestinal ulcers and bleeding
- Infection
- Mood changes
- Insomnia
- Osteoporosis due to long-term use
Side effects occur more frequently with long-term use or at higher doses. However, there are risks associated even with short-term use.
Adults taking oral corticosteroids over a period of 30 days or less have been found to be at increased risk of sepsis and bone fractures.
If you are worried about side effects or they are bothering you, talk to your healthcare provider.
Serious Side Effects
You should contact your healthcare provider immediately if you experience serious side effects such as:
- Vision problems, eye pain, redness, or tearing
- Sore throat, fever, chills, or other signs of infection
- Seizures
- Depression
- Frequent urination
- Increased thirst
- Confusion
- Excitement, restlessness
- False sense of well-being
- Hallucinations (seeing, hearing, or feeling things that are not there)
- Skin rash or hives
In rare cases, long-term use of high doses of corticosteroids can cause permanent bone damage called osteonecrosis or aseptic necrosis of the bone.
Most side effects will go away after you stop your treatment. However, some side effects—like glaucoma, cataracts, osteoporosis, and osteonecrosis (bone death)—may be permanent.
Easing Prednisone Side Effects
If you are affected by side effects due to taking prednisone, there are ways you can help to lessen their effect. To combat specific side effects such as bone density loss, consider taking potassium and calcium supplements. Speak to your healthcare provider before you take any supplements to discuss the right balance.
Other side effects may be reduced by adjusting the dose you are taking or changing when you take it. For example, taking all of your doses of prednisone earlier in the day could reduce side effects such as insomnia. It is important, however, that you do not try to change your dose or how you take prednisone yourself; always talk to your healthcare provider before making changes.
Beyond these steps regarding medication and symptoms, talking to those you are close to about side effects, including those that might affect them, such as mood swings or insomnia, can help them better understand and support you.
A Word From Verywell
In most cases, you will be taking prednisone to get your condition under control, and the goal will be to stop taking the drug as soon as possible.
You should discuss with your healthcare provider not just how the drug can manage the pain of your condition but also how taking it may cause other types of pain through side effects or withdrawal. Remember, do not stop taking prednisone suddenly; your healthcare provider will discuss how it needs to be tapered off.
Dealing with pain due to a chronic inflammatory disease can be challenging, and it can be difficult to find the right way to cope with it. You do not need to do that alone; your healthcare provider will help you develop a long-term pain management treatment.
