Prednisone for Pain

How prednisone is used to manage arthritis pain

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Prednisone is commonly used for short-term pain management of inflammatory diseases such as severe rheumatoid arthritis (RA). It is not a pain medication but it can help relieve your pain.

Prednisone belongs to a group of drugs called synthetic glucocorticoids, also called corticosteroids or just steroids, which act to raise your body’s adrenal hormone levels and reduce inflammation. It is best used as part of your overall treatment plan alongside other drugs to manage RA pain, such as those that work to slow the progression of the disease. 

When the symptoms of RA are exacerbated, prednisone is highly effective at relieving pain. However, it is not recommended for long-term use as other drugs are more effective and it has potentially serious side effects.

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How Prednisone Stops Pain

Prednisone stops pain by reducing symptoms such as inflammation and by suppressing your body’s immune system. Inflammation is how the immune system responds to your body being harmed, such as injury or infection. In RA, the immune system attacks its own tissues and cells, resulting in inflammation and tissue destruction.

The main 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, including RA. 

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. 

In addition to this, 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.  

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?

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.

Symptoms

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.

Reducing Pain Without Medications

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 for RA is generally started with a dose of 10-20 milligrams (mg) per day and then maintained at levels of 5 mg/day or more. Patients with extra-articular symptoms such as eye or lung inflammation are more likely to be on larger doses.

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 conditions and how you respond to treatment.

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 the mild to severe, are not uncommon. What kinds 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 tell you if you get an infection. It is recommended to take precautions such as staying away from people who are sick and washing your hands often whilst you are 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 You should 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, are:

  • 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.

Most side effects will go away after you stop your treatment, however there are some that may be permanent. If you are worried about side effects or they are bothering you then you should talk to your healthcare provider. 

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

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 you could consider taking potassium and calcium supplements. You should get advice from your healthcare provider before you take any supplements and so that you can get the right balance for you.

Other side effects may be reduced by adjusting the dose you are taking or changing when you take your dose. 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 pain through side effects or from withdrawal. Remember, do not stop taking prednisone suddenly, your healthcare provider will show you 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. 

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