Poly? Fibro?

What is the distinction between polymyalgia and fibromyalgia?

muscle34322The word myalgia means pain within the muscles. Both fibromyalgia and polymyalgia are characterized by muscle pain, but many other aspects of the two conditions differ.

Polymyalgia, or polymyalgia rheumatica, is an inflammatory disease of muscle. 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 also may have flulike symptoms, including fever, weakness and weight loss, and approximately 15 per cent develop a potentially dangerous condition called giant cell arteritis – an inflammation of the arteries that supply the head.

silhouette-roseFibromyalgia is not an inflammatory condition. 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. They are also typically tender points throughout their body. Other common symptoms of fibromyalgia include fatigue, difficulty sleeping and concentrating, irritable bowel syndrome and headaches.

Both fibromyalgia and polymyalgia are more common in women than men. Fibromyalgia can occur at any age, but polymyalgia rarely occurs before age 50. The average age of onset is 70. And whereas fibromyalgia is chronic, often lasting a lifetime, polymyalgia usually resolves itself within two years.

womanneckTreatment differs, too. Fibromyalgia is treated with exercise, relaxation techniques, analgesic medications and antidepressants to relieve pain and promote sleep. Treatment for polymyalgia is targeted at relieving inflammation. For some people, daily doses of NSAIDs, such as ibuprofen (Advil, Motrin), are sufficient, but more often corticosteroids, such as prednisone, are required to control inflammation.

Although polymyalgia will eventually go away completely, it’s important that to be mindful – both now and after your disease resolves – of symptoms such as headaches and blurred vision, which could mean giant cell arteritis. If you develop arteritis, high doses of corticosteroids may be necessary to control the condition and prevent vision loss.


Let’s Talk About Poo!

Back in early April, I made a quick reference to poo. Now that I’m on stronger pain killers, it may be time to revisit the discussion…

poo-2Most of us who live with FM also have Irritable Bowel Syndrome (IBS). FM and IBS are co-diagnosed in up to 70% of FM patients. IBS (also known as irritable colon, spastic colon, mucous colitis, or spastic colitis) is a disorder of the bowel, or large intestine. It is characterized by severe abdominal pain and cramping, changes in bowel movements, and a variety of other symptoms.

It has been estimated that as many as two-thirds of all IBS patients have FM, and as many as 70% of FM patients may also have IBS. These statistics differ greatly from the corresponding rates in the general population, where only 10%-15% of individuals are estimated to have IBS. It is unknown if the two conditions are related symptomatically or causally, or if their frequent co-occurrence is merely a coincidence.

Adding pain killers to the mix can be frustrating and painful.

Pain killers are used to combat headache, body ache, muscle pain, etc. Prescription painkillers including Vicodin, Darvocet, Percocet, OxyContin, Fentanyl, Tramadol and Lortab are widely prescribed to treat moderate to severe pain. At times (all the time?) we are forced to take painkillers due to too much pain. The opiate analgesics block pain signals by attaching to opiate receptors located in various parts of the body and brain. Prescription painkillers are effective treatments for chronic or persistent pain and can be taken safely, but these pain killers have side effects associated with them. Along with reducing pain, these pain killers also give rise to some other disorders as well.

bird_pooConstipation is a commonly reported effect associated with the use of prescription painkillers. Whether taking opiates at therapeutic levels or abusing them, many users report sluggish bowel movements, a condition which can be both annoying and painful. The problem can be compounded when we are taking a combination of prescription medications. Opiates can interfere with normal elimination by relaxing the smooth muscle in intestines and preventing them from contracting and expelling waste. With regular use of opiates, stools can become rock hard, blocking the bowels. In severe cases, bowels can rupture, leading to sepsis or death. Symptoms of constipation include: abdominal bloating, swelling and cramping; straining to pass stool; pain, discomfort or blood with a bowel movement; nausea; weight loss; and decreased appetite.

The use of a laxative or other form of stool softener is often suggested. Further, to prevent constipation, users must consume plenty of liquids when taking painkillers. Regular bowel movements could also be kept intact by consuming a diet rich in fibre. Mommy swears by prunes (yuck!) and a greasy, cheese pizza tends to work for me!

And, for the sake of completeness:

Mild and More Serious Side Effects

Even with short-term use, patients can experience one or more side effects. They can include sedation, euphoria, dizziness, fatigue, depression, tremors, sleeplessness, anxiousness, flu-like symptoms, upset stomach, dry mouth, pupil constriction, itching, hallucination, delirium, sweating, muscle and bone pain, confusion, extreme irritability and muscle spasms. Taking too much of an opiate medication, or more frequently than prescribed can be dangerous, even fatal. Combining opiates with alcohol and some other drugs can also lead to severe reactions. More serious side effects can include severe respiratory depression, confusion or stupor, coma, clammy skin, circulatory collapse and cardiac arrest.

Fibro? But Not Fibro?

Nice body, though? (Thought I’d sneak something nice in for us girls!)

Muscle pains, widespread aching and tenderness, joint pain, tendinitis pains, neuropathy-type pains and weakness – sounds like Fibro, right? Not necessarily; all of these symptoms can be reactions to drugs.

Drugs that may cause reversible FM-like syndromes are:

  • Cholesterol Lowering Agents: Lovastatin (Mevacor), Fluvastatin (Lescol), Simvastatin (Zocor), Pravastatin (Provachol), Atorvastatin (Lipitor) – Cholesterol lowering agents, especially HMG-COA reductase inhibitors are usually well tolerated but may cause pain in 1-7 per cent of people.
  • Anticonvulsants: Valproate, Ethsoximide, Carbamazepine, Hydantoins
  • Antiarrhythmics: Procainamide, Quinidine
  • Antibiotics: Minocycline, Isoniazid, Griseofulvin [Note: Minocycline is a generic quinolone/fluoroquinolone antibiotic, a family increasingly associated with tendon and muscle pain – or damage in a subset of perhaps genetically vulnerable patients.(1)]
  • Hormonal Therapy: Leuprolide Acetate (Lupron)
  • Antihypertensives: Hydralazine, Atenolol, Captopril, Methyldopa
  • Anti-inflammatories: Penicillamine, Sulfasalzine, rarely NSAIDs
  • Antipsychotics: Chlorpromazine
  • Antimalarials: Plaquenil
  • Gout medicines: Colchicine
  • Steroids
  • Alcohol
  • Cocaine

Tee Hee! And another one!

Painful side-effects from these drugs are uncommon; however, the dose and duration of treatment may affect pain. Some of the drugs are more likely to cause a painless weakness (still scary!) rather than painful muscles and joints (eg: steroids, alcohol, Colchicine). Unlike fibro, stopping the offending drug will usually result in complete reversal of the myalgias.

Stopping meds that you have been taking for long periods of time may also unmask FM, says Dr Mark J Pellegrino, a leading fibromyalgia specialist and author who has had FM himself since childhood. His observations reflect more than 20 years’ experience treating patients at the Ohio Pain & Rehab Specialists Centre. Examples of these medicines include hormone medicines such as thyroid medicines and especially estrogen medicines. There are numerous FM sufferers whose pains first started AFTER reducing or discontinuing long-term medication.

What does all this mean to you?

Not everyone with fibromyalgia-like symptoms has true fibromyalgia, so any drug-induced symptoms are expected to be completely reversed upon conclusion

Some with fibromyalgia-like symptoms from a drug may actually have true fibromyalgia, and the drug has aggravated the fibro symptoms. These people’s extra symptoms should settle down when the offending drug is removed, but may not be completely reversed.

And finally, some may have true fibromyalgia, and a prescribed, unrelated medicine helps mask potential symptoms that become noticeable only when the medicine is removed.