Polymyalgia Vs. Fibromyalgia : Differences Worth Knowing

Myalgia is a term used to refer to any type of muscle pain. Both polymyalgia and fibromyalgia are health conditions that cause pain and tension in the muscles of the body. While people often confuse the two conditions, and they do have some similar symptoms, they are two different conditions, and they vary in their symptoms, causes, and treatments. Getting an accurate diagnosis is essential to ensure you are on the proper treatment, which can help you manage your symptoms better. Read on to better understand the two conditions and see the differences and similarities in polymyalgia versus fibromyalgia.

Polymyalgia rheumatica is an inflammatory condition that causes muscle pain and stiffness in several parts of the body. It commonly affects the neck, arms, shoulders, and hips. The symptoms of polymyalgia usually appear suddenly and tend to be worse in the morning.^{(1, 2, 3, 4)} This condition is known to affect people over the age of 65, and it is rarely witnessed in people under the age of 50. Polymyalgia also affects women more than men, with people of Scandinavian and Northern European descent being at a greater risk of developing the disorder.^{(5, 6)}

On the other hand, fibromyalgia is a chronic or long-term condition that causes symptoms like musculoskeletal pain, tenderness, sleep and cognitive disturbances, and general fatigue. This is a challenging condition to understand, even for doctors. The symptoms of fibromyalgia often mimic the signs and symptoms of other conditions, and neither are there any tests to confirm the diagnosis of fibromyalgia. Due to this, fibromyalgia is usually misdiagnosed. In the olden days, some doctors even questioned the existence of fibromyalgia, but today the conditions are still better understood.^{(7, 8, 9, 10)}

It is estimated that around four million adults in the United States alone (roughly two percent) have been diagnosed with fibromyalgia. Most cases of fibromyalgia are typically diagnosed in females, and most people get diagnosed in their middle ages itself. However, fibromyalgia can also affect children.⁽¹¹⁾

Polymyalgia rheumatica and fibromyalgia are both musculoskeletal conditions that have symptoms that can be difficult to tell apart. When you have polymyalgia rheumatic, you experience stiffness and pain in the muscles in the shoulders and upper arms (or the shoulder girdle) and hips (the pelvic girdle). This sensation usually comes after spending some time resting, and it is generally most severe when you wake up from sleep.

On the other hand, fibromyalgia can also cause muscle pain in the same parts of the body, but it is more widespread, and the pain is also more severe. People with fibromyalgia also tend to experience other symptoms, including:

• Memory issues
• Trouble sleeping
• Fatigue
• Bowel and bladder problems

Similarities and differences in the symptoms of polymyalgia and fibromyalgia may include:

• Location of the Pain: People who have fibromyalgia tend to experience pain on both sides of the body, generally in 28 key places.⁽¹²⁾ People with polymyalgia, though, tend to feel pain and stiffness in their back, shoulders, and hip girdles.
• Mental Health: Both these conditions may lead to depression related to having to live with a painful and chronic condition. A study from 2017 associated fibromyalgia with higher than average rates of post-traumatic stress disorder.⁽¹³⁾ People with fibromyalgia tend to sometimes report difficulties in concentrating or have a sense of mental fog.
• Sleeping Difficulties: Many people with fibromyalgia experience trouble sleeping.
• Morning Stiffness: Both the conditions of fibromyalgia and polymyalgia causes the joints and muscles to feel stiff. Polymyalgia usually causes morning stiffness that can last for less than an hour.^{(14, 15)}

Polymyalgia rheumatica is diagnosed more frequently during certain seasons. This suggests that there is an environmental connection to the disease, such as a virus. Some diseases like rheumatoid arthritis and other autoimmune disorders are linked with a greater incidence of fibromyalgia. Post-traumatic stress disorder and other types of emotional or physical traumas are also linked to be the cause of fibromyalgia.

Fibromyalgia pain is believed to be caused by overactive nerves that make the body feel pain despite the lack of any physical injury. This shows that fibromyalgia might occur because of the manner in which the nerves and brain perceive sensation, while polymyalgia develops because of a problem with the immune system.^{(16, 17, 18)}

The diagnosis of fibromyalgia focuses on excluding other underlying conditions that might be causing the symptoms. This means that when a person experiences widespread chronic pain throughout the body, and the healthcare team is not able to find any other cause, they may diagnose fibromyalgia. There is no one diagnostic test to determine if a person has fibromyalgia. However, a physical examination that checks for certain tender points on the body can prove to be helpful. A doctor is also likely to collect blood samples to rule out inflammatory disorders such as polymyalgia and rheumatoid arthritis.

Blood tests are usually used to diagnose polymyalgia. Most people with polymyalgia have increased levels of certain inflammatory proteins in their bloodstream, and their red blood cells are also likely to show signs of changes that are typical of inflammation.^{(19, 20, 21)}

A doctor may also carry out other tests to rule out other inflammatory conditions, including a biopsy or blood test to check for rheumatoid factors. These tests are considered to be standard for people with polymyalgia but not for those who have some other conditions.

For the diagnosis of polymyalgia, imaging tests such as ultrasound or X-rays can also be used.

Treatment for polymyalgia focuses on decreasing inflammation, while treatment for fibromyalgia focuses on managing your pain and reducing central sensitization.

It is important to understand that there is no cure for polymyalgia rheumatica. However, with the right kind of treatment, symptoms can be improved within even 24 to 48 hours. Your doctor is likely to prescribe a low-dose corticosteroid, such as prednisone to help bring down the inflammation.^{(22, 23)} The standard dosage of corticosteroids is between 10 to 30 milligrams per day. Most people with polymyalgia rheumatica are unlikely to get relief from the symptoms of the disease by taking over-the-counter pain medications like naproxen and ibuprofen.

While corticosteroids are effective in treating polymyalgia, these medications have many side effects, and the long-term use of these drugs can increase the risk for the following:^{(24, 25)}

• High cholesterol levels
• High blood pressure
• Weight gain
• Depression
• Cataracts
• Osteoporosis
• Diabetes

To lower the risk of developing such side effects during polymyalgia treatment, your doctor may recommend that you take a daily vitamin D and calcium supplement. Your doctor may also suggest to do physical therapy to help boost your strength and increase your range of motion.

Fibromyalgia can be challenging for a person to manage by themselves. A rheumatologist or another specialist doctor will help design a treatment problem that will help manage the condition.⁽²⁶⁾ A complete treatment plan for fibromyalgia usually involves a combination of nonpharmacological and pharmacological therapies.

Fibromyalgia is considered to be a syndrome, and every person tends to experience a different set of symptoms, and this is why an individual treatment plan is necessary. Treatment for fibromyalgia may include some or all of the following:

• Acupuncture
• Low impact exercise program
• Chiropractic
• Massage
• Stress reduction techniques
• Physical therapy
• Psychotherapy such as cognitive-behavioral therapy (CBT)
• Medications such as muscle relaxants, antidepressants, and nerve pain medications

Your doctor may recommend medications for the treatment of some fibromyalgia symptoms, which may also include some over-the-counter pain relievers.

However, in 2016, the European League Against Rheumatism (EULAR) issued updated guidelines that recommended against the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for treating fibromyalgia.⁽²⁷⁾

Doctors may also prescribe anti-seizure drugs like pregabalin (brand name: Lyrica) and antidepressants like duloxetine (brand name: Cymbalta) and milnacipran (brand name: Savella).

Remember to let your doctor know about any other medications that you are taking to prevent any interactions and side effects with other medicines.

It is not always possible to tell who has a higher likelihood of developing either of these conditions. However, there are certain risk factors that help provide some clues. According to research, older adults (over the age of 65) are more likely to be diagnosed with polymyalgia, and it is rare to find this diagnosis in people under the age of 50.⁽²⁸⁾

On the other hand, though, it is possible for anyone to get fibromyalgia. However, it is more common in women than in men, and it can develop at any age.⁽²⁹⁾

Both polymyalgia rheumatica and fibromyalgia are chronic (long-term) and painful disorders. The symptoms may change over time but are unlikely to go away completely. The right treatment of polymyalgia with corticosteroids can help ease the symptoms, but you may experience a relapse. It is important to keep in mind that there is no cure for either fibromyalgia or polymyalgia. However, with the appropriate treatment, both conditions can be managed.

People with fibromyalgia may try out various remedies before coming across one that works best for them. Those with polymyalgia can usually find quick relief with the right treatment, such as corticosteroids. However, at the same time, doctors have to monitor people with polymyalgia for any signs of a blood vessel condition known as giant cell arteritis.

It is always essential to get professional advice and guidance when you are dealing with chronic pain.

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