I tried to find some information that would clarify some of the ideas here but didn't have much luck so the best I can say is that there does seem to be a trigger somehow between cortisol levels and the pain of PN.

I've been on a steroid inhaler for 7 years that can "rarely" cause adrenal suppression. My pulmonologist likes to 'mushroom' his patients (keep them in the dark and feed them BS) so I can't say for sure I have it, but I've developed weird allergies and apparent asthma, went into hypovolemic shock from the laxative when I had a colonoscopy (eek) and a few weeks later had what appeared to be a convulsion in response to extreme stomach pain. My COPD isn't severe enough to make me that fragile and from what I've read problems in tolerating physical stress are characteristic of adrenal suppression. My body temperature dropped a degree at some point after I started it as well.

I didn't have any PN until I'd been on the meds for 2-3 years and there seems to be a pretty direct linear relationship between the amount of steroid I'm taking and the degree of pain, more drug = more pain. I tried to go off it entirely but couldn't breathe (it can 'worsen' asthma, I think it can GIVE you asthma). I stopped it a couple of times and the first time I restarted it I could feel a burst of burning/prickling in my feet shortly after I took it, and the second time I could actually feel it traveling down my thigh and hitting my feet to cause burning. I don't know if I was feeling nerve transmission or if the sensation was vascular but I felt it. It is known to cause muscle rigidity and stiffness that seems to target the small neck muscles and I also felt a little 'herky-jerky' sensation in my neck that felt like you might think a nerve transmission could and my neck stiffened back up. I don't know if that was nerves or muscles though.

I'm not sure how much of this is relevant to people who may have natural suppression but cortisol levels vary throughout the day and maybe pain could occur when you get a burst and your nerves just don't appreciate too wide of fluctuations. I don't know what is going on with the heat, my feet get hot to the touch too but I thought that was vascular. It does feel like the nerves are revved up and generating heat more than the warmth you get from a hot bath or something. My pain is rarely if ever triggered by a bath, etc, it takes prolonged exposure like hot weather.

I'm not sure if I exactly fit here, but I really admire the people in this forum. I know how much it hurts and you keep on truckin' and trying to learn. '
Zygo

"Take 2 cats and call me in the morning"..