Could I have developed fibromyalgia as well as PMR?

[katiemills]

Greetings, everyone . I have a question for you experienced folk out there- could the new pains I am experiencing be fibromyalgia? I was diagnosed with PMR 2 years ago and have typical symptoms- pain in my shoulders, neck and upper arms and pain around my thighs and hips as well as fatigue. I had a fall a month ago which caused me to flare a bit ( I went up from8.5 mg to 10 mg. ) and over the last month I have developed a pain in my diaphragm and rib cage as well as a rather sharp pain in my thoracic spine which I didn’t have immediately after my fall.

My GP thinks it’s possible but isn’t too sure . I have a telephone appointment with the pain clinic consultant on Friday and am wondering which are the best drugs to make life more bearable and help me sleep at night when the pain everywhere is worse. At the moment I take 10mg prednisone. 15 mg methotrexate, 6 x5 mg folic acid, omeprazole , calci D 20 mg amitriptyline at night and tramadol and paracetamol when I need them. My GP thinks it might be a good idea to increase my amitriptyline .

Do any of you have both fibromyalgia and PMR and could my new pains in my diaphragm, ribs and upper spine be fibromyalgia pain?

Apologies for the long post !

[SnazzyD]

If it was me, I’d go and see an osteopath or chiropractor or really good physio. It is quite possible you’ve got something a bit out of line from the fall, especially if you have thoracic spine, chest and diaphragmatic pain which are all linked. More chronic musculoskeletal problems can occur from falls that aren’t always apparent soon after the event. Also, any sort of unbalanced posture or tension due to pain from the injury can set up problems later on. I’ve had a similar problem in the past and a muscle pull in my lower ribs had set up some spasm that pulled on other structures out of line too. It was fixed very quickly. I’ve had Fibro on and off for year, and although we are all different, it doesn’t sound like the right sort of pain to me. For me it could be an intense but still diffuse pain in rough areas, not specifically in certain bits like the spine.

[katiemills in reply to SnazzyD]

Thanks for replying . I think you could be right. I will try to get to an osteopath and see if that puts me right .

[SnazzyD in reply to katiemills]

Well, at least if it does fix it you’ll have saved yourself more Pred and possibly more traipsing round docs for another diagnosis.

[Flutterbies57 in reply to SnazzyD]

I agree with SnazzyD. I have had Fibro for 24 years. I think you should try a good Osteo or Chiro first, and I do hope you do not have Fibro. I hope all goes well for you

[SheffieldJane]

Presumably you’ve had X Ray results? Has Costochondritis been explored, inflammation of the junctions where the upper ribs join the Costal cartilage? Very painful and often goes hand in hand with PMR.

I am not very knowledgeable about Fibromyalgia. A number of people on the forum suffer this condition in addition to PMR/GCA. I believe that the points of pain have a particular pattern. Are you up to date with a Dexa Scan ( bone density)?

Doctors are keen on Amitriptyline as a painkiller although it is not without side effects. I found 10 mgs an hour before bed, helped with sleep and physical comfort. Good luck with the pain clinic!

[katiemills in reply to SheffieldJane]

Thank you for replying. Our GP practice is only working for emergencies , so no, I haven’t had an X-ray . My last dexa scan was 2 years ago and everything was fine . Costochondritis Is a real possibility, thank you .

[MrsNails]

Hi what dose of Amitriptyline are you on? I’ve been as high at 30mg but now on 10mg but it a Drug favoured by the Pain Management Guys as it relaxes the muscles; my recommendation is to take it about 7.30pm & not just before bed, it takes a while to ‘work’ but if you take it early you won’t get that fuzzy, hung over feeling in a morning.

I don’t know much about Fibromyalgia but there are Members on here who have both so they may be along later.

Have they tested your bloods? It maybe that the Pred is not sufficient to hold the PMR at bay but the Pain Guys may consider that also.

As a point of interest, it was a Pain Management Specialist who diagnosed me in the first instance......

Good Luck 🍀 & let us know what they have to say.

Cheers

Angela xx

[katiemills]

Hi Angela thanks for replying. My bloods are now being tested at 2 monthly intervals. I’m only on 20 mg Amitriptyline at night so my GP was wondering whether I should increase to 50 mg and take some in the day . I struggled to get down to 8.5 mg pred and think I’m going to be stuck on 10 mg for a while now . I’m lucky to have an appointment with the pain management consultant On Friday . How are you ? Are you still ok on the methotrexate? What pred are you taking now ? Xx

[MrsNails in reply to katiemills]

Hi Katie

That’s a big jump to 50mg see what the Pain Guys think....

If l took it in the day, l’d be wiped out but the Pain Guys will advise.

Make sure you’ve a list of points & questions & tick them off as you cover them, ask if they will send you a copy letter with all advice/recommendations on so there’s no ambiguity.

They will sometimes offer an antidepressant as part of the Pain Management, so try not to be resistant to that option, l think that’s maybe what the GP is thinking but there are much better, non sedating antidepressants around these days, l took Citalopram & remained on my night dose of Amitriptyline about a year after my Cancer Diagnosis.

Yep l’m still on the MTX & 12.5mg Pred but my PMR is flaring, lots of the insidious signs, burning face, pain in my bicep, burning in my muscles etc; l’m kinda fed up of it to be honest

I’ve tried increasing the Pred but the Drs get very jumpy with all my other conditions......

I think l may write another one of my Epistles to DrD & outline again how poorly l feel as l do tend to minimise how l am & get ‘Angela’ out of the Box 🎁 to perform 😉

Let me/us know how you get on......

Cheers & Thanks for asking

Angela x

[katiemills in reply to MrsNails]

Oh I forgot to say I’m on sertraline anti - depressant . I’ll message you after Friday . I’m so sorry you’re suffering so much 😢

[MrsNails in reply to katiemills]

The Pain Guys like a multi prong treatment to pain as it affects your whole body/mind.

We hang in there though don’t we! 🙏🏼😉🌺

[PMRpro Ambassador]

I'd be more interested in having an x-ray to rule out bone damage in the thoracic spine.

Then, Snazzy's idea is also very relevant: in myofascial pain syndrome a fall can cause spasmed muscles which then irritate or even trap nearby spinal nerves and cause referred pain in the regions they supply. One particularly common pair of trigger points in MPS is on either side of the spine at about rib level - that causes referred pain in the ribs, right round to the front. I agree what you say doesn't sound very fibro-ish. Mine is managed by our pain clinic - but it is a bit different from the UK.

Personally - I'd say that an injury that needed a bit of clarification via x-ray is a potential emergency. And sorry - no, GP practices are not supposed to be only working for emergencies. They are meant to be working.

[katiemills in reply to PMRpro]

Thanks for replying in such detail . To be fair to my GP he did query whether I might have fractured my spine , but I dismissed it because I have fractured vertebrae in the past and the pain is much more localised . I’m sure he would have sent me for an X-ray if I’d requested one . What the surgery are not doing is seeing patients unless they have an emergency , which mine isn’t . All appointments are on the phone .

Anyway , all you folk have been very helpful and I think it’s probably myofascial pain syndrome not fybromyalgia. Interestingly though The Mayoclinic.org website says that “ Some research suggests that MPS may develop into fybromyalgia in some people “ I hope I’m not one of them !!!

[PMRpro Ambassador in reply to katiemills]

I suspect that may be in the form of "learned pain". And perhaps they don't realise that the trigger points of MPS coincide with some of those of fibro.

What they SHOULD be saying is that MPS may develop into PMR - as now there does appear to be a link in the pathology which even the English-speaking world is realising. The Germanic part of Europe has known for years - at least 6 or 7 years ago I attended an international medical meeting in Innsbruck where they discussed the similarities between the trigger points in MPS and PMR inflammation and it was a rerun of a seminar given there a couple of years earlier.

jrheum.org/content/46/12/1552

[powerwalk]

I have fibro, i had it before pmr. Would be wisespread muscle pain mainly. Diaphragm pain pain doesnt sound fibro but honestly i think they sometimes put everything into "fibro". I hope you get sorted. Especially after a fall, in case you have done some damage.

[katiemills in reply to powerwalk]

Thank you . I think PMR Pro is probably right - as she usually is !

[Pixix]

Yes, I do. But I personally don’t have pains from my fibromyalgia in those places. If you google Fibromyalgia you will find a ‘map’ of the body & see the pain sites...you need to be positive you have fm from that chart & your medical visits, I think. I sort of remember there are 18 pain points & you have to have 11 of them to truly indicate Fibromyalgia...these numbers may be inaccurate as I’ve had it over ten years! More pain than pmr in my case as nothing controls it in the way that steroids help pmr. Pain is very widespread but so are the body ‘points’ in the fm ‘map’! Drugs used in fm...well, I’m on Tramadol, paracetamol, amitryptylline, all of which you mention, but a lot of people take gabapentin or Pregabalin. I tried both & failed, the side effects were too great (& evil)! But I think you need to go back to the medics next, really. Hope this helps a bit, To me it doesn’t ‘sound’ like typical fm, but I’m not a doctor!

[katiemills in reply to Pixix]

Thank you , your reply is very helpful . Thanks to everyone’s input , I don’t think I have fybromyalgia, I think it’s myofascial pain syndrome . I suspect the pain management consultant will keep me on the drugs I’m on , but I’m interested to hear what he has to say .

[Pixix in reply to katiemills]

Always happy to help...and I wouldn’t wish the Combination of Fibromyalgia & polymyalgia on anybody...it’s naff (polite way of putting it)! Good luck with finding a diagnosis & the best way to manage it! S x