Knowing Your ‘Myalgias’
For many, every day is a battle with muscle pain, stiffness and fatigue. Unfortunately those are common symptoms of multiple conditions, so sometimes it isn’t easy to know exactly what you are experiencing.
Do you truly know your “myalgias?" You can help your physician give an informed diagnosis by understanding the differences between very similar conditions, such as fibromyalgia and polymyalgia, so you can better explain and discuss your symptoms with him or her.
The word “myalgia” means pain within the muscles. Fibromyalgia and polymyalgia are conditions with symptoms that may be hard to tell apart, both characterized by muscle pain. When you have polymyalgia, you feel pain and stiffness in the muscles in your shoulders, arms, hips and neck. This feeling often comes after you’ve spent time resting. Fibromyalgia can also cause muscle pain and stiffness in the same parts of the body.
But aside from the similar characteristics concerning the muscles, many aspects of the conditions differ.
Not Two Sides of the Same Coin
Polymyalgia rheumatica — polymyalgia for short — is an inflammatory disease of muscle and joints. The cause is uncertain but it is believed to be an autoimmune disease in which the body’s own immune system attacks the connective tissues.
The primary symptoms are severe stiffness and pain in the muscles of the neck, shoulder and hip areas. People with this condition may also have flu-like symptoms, including fever, weakness and weight loss, and approximately 15 percent develop a potentially dangerous condition called giant cell arteritis — an inflammation of the arteries that supply the head.
Fibromyalgia is not an inflammatory condition exactly, but more a neurological one; it is caused by abnormal sensory processing in the central nervous system. People with fibromyalgia may be extremely sensitive to pain and other unpleasant sensations. To be diagnosed with fibromyalgia, one must experience pain on both sides of the body and in both the upper and lower half of the body.
There are also typically tender points throughout the body. Other common symptoms of fibromyalgia include fatigue, difficulty sleeping and concentrating, irritable bowel syndrome, memory problems and headaches.
It’s not always easy to tell who has a greater chance of developing each condition — however, certain risk factors provide some clues. According to the Mayo Clinic, seniors are more likely to be diagnosed with polymyalgia. It’s rare in people under 50 and those it affects are usually over 65 — the average age of onset is 70.
On the other hand, anyone can get fibromyalgia. However, according to the National Institutes of Health (NIH), it’s more common in women than in men. Actually, both fibromyalgia and polymyalgia are more common in women than men. Women are two times more likely to develop polymyalgia than men, and if they are of northern European or Scandinavian decent, the chances are higher still.
Fibromyalgia can occur at any age, and whereas fibromyalgia is chronic, often lasting a lifetime, polymyalgia usually resolves itself within two years if properly treated.
Both fibromyalgia and polymyalgia can run in families. In other words, having certain genes can increase your risk for developing either disease. This is true of many diseases. Studies by the Mayo Clinic show polymyalgia is more frequently diagnosed in certain seasons. This suggests that something in the environment, such as a virus, might play a role. Some researchers believe that it is caused by the adenovirus respiratory infection.
No one is completely sure of the causes of polymyalgia though. It is thought by some to be related to rheumatoid arthritis, while others believe it is actually a genetic disorder. Another possible cause or factor is an autoimmune disease. As previously stated, polymyalgia may result from an autoimmune disorder in which white blood cells attack the lining of the joints, causing inflammation.
Some illnesses and infections, such as rheumatoid arthritis, and other autoimmune disorders can cause fibromyalgia as well. Post-traumatic stress disorder and other emotional or physical traumas can trigger it as well. So while both diseases display many of the same conditions and issues, they differ in their origin, onsets and triggers.
A Closer Look
Since fibromyalgia and polymyalgia have some similar symptoms and often run along a parallel course even though they do differ, exactly how is a proper diagnosis determined and what are the steps towards help for each of the conditions?
There are some tests and factors that can assist your doctor in determining whether or not you are dealing with polymyalgia vs fibromyalgia. Your role in this process is very important as we mentioned form the outset. Keep track of your symptoms, your environment when there is a worsening of conditions, and flare-ups and frequency as well as duration of symptoms.
Once you meet with your doctor, they may want to conduct a number of tests to make a diagnosis of polymyalgia rheumatica, including:
- Blood tests
- Imaging tests such as MRI or ultrasound
- Monitoring for the condition of giant cell arteritis
Below are some details concerning the type of tests that you may undergo when a doctor has a suspicion that you may be suffering from polymyalgia rheumatica.
Your health care provider will perform two blood tests to confirm the diagnosis:
Sed rate is a measure of the time it takes your blood cells to fall to the bottom of a test tube; referred to as erythrocyte sedimentation, blood cells fall faster when exposed to inflammation. A fast reading could indicate polymyalgia rheumatica. Those with polymyalgia have a high sed rate while that of a fibromyalgia sufferer is usually normal.
A Closer Look
Rheumatoid Factor (RF)
RF is a measurement of rheumatoid factor hormone in your blood stream. People with RF in their blood cannot have polymyalgia rheumatica.
Concerning the diagnosis of fibromyalgia, there are no lab tests in existence that can accurately confirm a diagnosis. Your doctor may try to first rule out conditions with similar symptoms through the previously mentioned blood tests.
One thing that may be a telltale sign that you are dealing with polymyalgia (aside from the age factor that is a common thread) as opposed to fibromyalgia, is the fact that symptoms of polymyalgia rheumatica tend to appear suddenly and without warning. Many sufferers develop severe pain in just a week or two, while others develop symptoms overnight. Fibromyalgia tends to creep up slowly on a patient before it is full-blown.
Now I Know — What Next?
Even though fibromyalgia and polymyalgia produce a few of the same symptoms and conditions, treatment is different because the causes are different.
Because polymyalgia is primarily a physical condition based on pain and stiffness, first-line treatment usually involves corticosteroids like prednisone to relieve symptoms. This is because treatment is targeted to reduce inflammation. For some people, daily doses of NSAIDs, such as ibuprofen (Advil, Motrin), are sufficient. Naproxen is also an anti-inflammatory sometimes used to relieve mild pain and swelling.
However, non-steroidal and anti-inflammatory medicines as well as anti-depressants only go so far and are relatively ineffective if the pain and swelling is more severe. More often, corticosteroids, such as prednisone, are required to control inflammation and moderate to severe pain. Steroid medication shows signs of improvement in patients within a few days, but may be continued for up to two years.
In addition, a healthy diet and exercise can help to manage pain and increase muscle flexibility and range of motion. Cardiovascular fitness exercise is much more beneficial than just treatment with medications alone. Another way you can better manage polymyalgia is to take steps to make your daily tasks go more smoothly — simple things like rolling suitcases when you travel and avoiding wearing high heels to prevent falls when you are stiff and in pain.
Fibromyalgia is improved with some of the same techniques as polymyalgia, but requires a more complex method of effective management. Conventional treatment of this condition with pain relievers and antidepressants is relatively ineffective. Even the designated medications such as Cymbalta, Lyrica and Savella only do so much if this is the only form of treatment and pain management. A low-fat diet and regular exercise can make a big difference in preventing and soothing the pain, stiffness and fatigue associated with fibromyalgia. FM sufferers may also feel better by practicing good sleep habits and pacing their activities to avoid overdoing it. Developing a routine of exercise and relaxation techniques that promote better sleep goes a long way to improving the symptoms of fibromyalgia.
Knowledge Is Power
Experiencing the symptoms of either polymyalgia or fibromyalgia can be challenging and frustrating. Polymyalgia patients may have to contend with daily medication to ease their pain and stiffness. In addition to dealing with pain and fatigue, fibromyalgia patients may have to handle feeling misunderstood by others — even those in the healthcare community.
Use what you know about your condition to seek support from family, friends, co-workers, and your doctor. Taking steps to manage your specific symptoms can bring a feeling of control as well as relief. Share that knowledge with others who are walking the same path as you and you will soon realize that you are not alone and there is hope and life beyond and in spite of these frustrating and debilitating conditions.