Not a month goes by that some patient is not referred to me with a diagnosis of “polyfibromyalgia”. Or “fibromyalgia rheumatica”. Or “polymyalgia”.

Say what?

But it is easy to be confused. And when a person suffers pain on a chronic basis, from the patient perspective, maybe a rose really is a rose and a rose.

Alas, the referring physician does not have that excuse; but let that be the grist for a whole other blog.

Of course, from the rheumatologist’s perspective, it does make a difference what is causing muscle pain. The respective treatments can be radically different, depending on the diagnosis.

POLYMYALGIA RHEUMATICA (PMR) is a common inflammatory disease of older individuals. PMR is also subject to wide variations in clinical practice, likely because of the uncertainty related to its diagnosis and treatment. There is no specific diagnostic test, and physicians will often use a “test of treatment approach” to establish the diagnosis: A trial of prednisone will be given, and if the patient markedly improves within 48 hours, then one becomes fairly comfortable with establishing a diagnosis of PMR.

The classic pain and stiffness in the shoulder and hip girdle muscles seen in PMR can occur in many other rheumatologic illnesses. Making things more complicated is the fact that many PMR patients may have more distal manifestations such as arthritis and carpal tunnel syndrome.

FIBROMYALGIA, in contrast, is not an inflammatory disorder, and is seen more frequently in middle age, increasing in prevalence with the aging population; one can see how a confusion with PMR might occur. Fibromyalgia is a disorder of unknown etiology characterized by widespread pain, abnormal pain processing, sleep disturbance, fatigue and often psychological distress. People with fibromyalgia may also have other symptoms; such as,

o Morning stiffness

o Tingling or numbness in hands and feet

o Headaches, including migraines

o Irritable bowel syndrome

o Problems with thinking and memory (sometimes called "fibro fog")

o Painful menstrual periods and other pain syndromes

POLYMYOSITIS is an inflammatory muscle disease that causes symmetrical, upper arm and upper leg muscle weakness; elevated skeletal muscle enzyme levels; and characteristic electromyography (EMG) and muscle biopsy findings. Clinically similar to polymyositis, dermatomyositis is another inflammatory muscle disorder associated with characteristic dermatologic manifestations. Inclusion body myositis is a slowly progressive muscle disease with characteristic pathologic findings that is generally found in older males.

MYOFASCIAL PAIN SYNDROME, like fibromyalgia, is a chronic, non-inflammatory pain disorder. In myofascial pain syndrome, pressure on sensitive points in the muscles (trigger points) causes pain in seemingly unrelated parts of your body. This is called referred pain. This pain typically occurs after a muscle has been contracted repetitively, as is seen with repetitive motions used in jobs or hobbies, or by stress-related muscle tension. It is quite often a result of misaligned posture.

While we all have experienced muscle tension pain, the discomfort associated with myofascial pain syndrome persists or worsens. One of the main characteristics of myofascial pain syndrome is that the pain is regional, or confined to a limited area of the body. Generally, myofascial pain will be found in the shoulders, neck, arms, face, low back and/or legs.

So, you can appreciate the creativity of the diagnostic nomenclature. And you can hope for the competency of those making the diagnoses.

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