How can you know if it’s steroid withdrawal or too quick a reduction?

Bones, joints and muscles
1

I've dropped from 10mg to 9 using the slow method. About half way through the month I started getting twinges in my shoulders again, but persevered (I had none when I was on 10mg). Now I'm a week into being completely on 9mg only and that familiar pain in my lower back has started to resurface as well. I really want to be able to reduce very gradually, but I'm reluctant to go back onto 10 if these symptoms are from withdrawal -- but how can I tell the difference?

Started on 10mg September 2018

2

Most likely you need higher dose ( still). If the symptoms come from steroid withdrawal , they usually become weaker over time and disappear. On the other hand, if it is due to too low dose, then accumulated inflammation over time causes symptoms to become stronger. Why not go back to 10 and then after couple of weeks, when symptoms go away, try 0.5mg reduction from 10 to 9.5 and see if you can tolerate that?

3

Thank you Nick, I think you’re right, back up to 10 this morning, and I’ll try the reduction at 0.5 as you suggest.

4

Withdrawal symptoms start immediately you change the dose (it is your body objecting to not getting the dose it expected) and then improve over the following couple of weeks at most usually. A flare is because the dose you are on is now too low, takes at least a few days to appear and then gets worse with time. The whole point of the slow tapers is to reduce the likelihood of steroid withdrawal by making the step down much more gentle.

If the pain hasn’t started until after a week at the new dose then it is far more likely to be a flare, the 9mg is probably only very slightly too little and it takes time for the inflammation to build up to a level that causes discomfort and then, later, real pain. It is perfectly possible that 9.5mg is enough even if 9mg isn’t.

5

PS - it isn’t the SPEED of the drop - it is simply the dose is now too low. I wrote a post years ago about how much difference 1/2mg could make - and that was 1/2mg in a 2-day dose!!

6

Thanks Eileen, your comments and Nick’s confirm what I was thinking. I’m just at the beginning of this, so I am finding your advice and experience an absolute godsend! Thank you so much for being so proactive with us newbies!