What is the recommended prednisone (corticosteroid) taper regimen for neck pain?

Prednisone Taper Regimen for Neck Pain

For neck pain, the recommended prednisone taper regimen is to start with 0.5-1 mg/kg/day (typically 30-60 mg daily) for 2-4 weeks, followed by tapering by 10 mg every 2 weeks until reaching 10 mg daily, then more gradually reducing by 1 mg every 4 weeks until discontinuation. 1, 2

Initial Dosing

• Start with prednisone 0.5-1 mg/kg/day (typically 30-60 mg daily)
• Administer as a single daily dose rather than divided doses (except in cases of prominent night pain when below 5 mg daily) 1
• Continue initial dose for 2-4 weeks depending on clinical response 1, 2

Tapering Schedule

1. First phase (higher doses):

   • Reduce by 10 mg every 2 weeks until reaching 20 mg/day 1, 2
   • At 20 mg/day, slow the taper to 5 mg every 2 weeks until reaching 10 mg/day 1

2. Second phase (lower doses):

   • Once at 10 mg/day, slow the taper to 2.5 mg every 2 weeks until reaching 5 mg/day 1
   • Below 5 mg/day, taper by 1 mg every 2-4 weeks until completed 1, 2

Example Taper Schedule for 60 mg Starting Dose

Weeks	Dose
1-2	60 mg daily
3-4	50 mg daily
5-6	40 mg daily
7-8	30 mg daily
9-10	20 mg daily
11-12	15 mg daily
13-14	10 mg daily
15-16	7.5 mg daily
17-18	5 mg daily
Then reduce by 1 mg every 2-4 weeks until discontinuation

Special Considerations

Efficacy Evidence

• A randomized controlled trial demonstrated that a short course of oral prednisone (50 mg/day for 5 days, tapered over the following 5 days) was highly effective in reducing pain in patients with cervical radiculopathy compared to placebo 3
• Pain improved in 75.8% of patients receiving prednisolone versus 30% in the placebo group 3

Management of Relapse

• If symptoms worsen during tapering, increase the dose to the pre-relapse level 2
• Maintain this dose for 2-4 weeks until symptoms improve 2
• Resume tapering more gradually once stabilized 2

Side Effect Prevention

• Consider calcium (800-1000 mg/day) and vitamin D (400-800 units/day) supplementation for courses exceeding 3 months 2, 4
• Monitor for steroid-related side effects including:
  • Cosmetic changes (facial rounding, weight gain, acne)
  • Osteopenia
  • Hypertension
  • Hyperglycemia
  • Mood changes 1

Alternative Approaches

• For patients with significant steroid-related concerns, consider:
  • Alternate-day dosing (e.g., 10 mg/7.5 mg on alternate days) once at lower doses 1
  • Adding a steroid-sparing agent for prolonged treatment 2
  • NSAIDs may be effective for milder cases or as adjunctive therapy 5

Monitoring

• Follow up every 4-8 weeks during treatment to assess:
  • Clinical response
  • Steroid-related side effects
  • Signs of adrenal insufficiency during tapering 2

Cautions

• Avoid rapid tapering (e.g., 10 mg every 3 days) as it risks adrenal insufficiency 2
• High-dose prednisone (>30 mg/day) is strongly discouraged for long-term use due to increased risk of adverse effects 1
• Be vigilant for signs of adrenal insufficiency during tapering (fatigue, weakness, dizziness) 2

This regimen balances the need for effective pain control with minimizing steroid-related adverse effects through a structured, gradual taper approach.