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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18422
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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What is the difference between polymyositis and fibromyalgia

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What is the difference between polymyositis and fibromyalgia (which I have to say, I barely even believe in - it sounds like "I-don't-like-to-work-itis" to me)? After several weeks of increasing pains and some weakness, my primary doc sent me to a rheumatologist. The only blood work that was out of normal limits was my CK at 1411, my ANA which was "mildly positive" (but I don't remember the number), and several positive results on Epstein Barre, but the doctor said those only showed an "old" EB infection. She put me on methylprednisone 12mg daily and methotrexate 15 mg a week. For me, the fatigue is really not so bad, but the pain is just miserable. I feel like it's hard to talk to the specialist about the pain. She seems surprised that I find it so bad, and she seems to think I want narcotics so she barely addresses my questions. She did prescribe tramadol which made me itch and turn red but did nothing for my pain. I talked a local walk in clinic into giving me an IV dose of (Toradol) ketoralac 60 mg which was heaven. No pain hardly at all for almost 8 hours. (I know I can't keep on taking that.)

SO my question is, is the pain unusual with polymyositis or could I have fibromyalgia? In either case, is there some non-narcotic, non-steroidal help for the pain? I tried po ibuprofen, but the doctor said I shouldn't take that with the steroids.

The key difference between polymyositis and fibromyalgia is that the polymyositis has true inflammation in the muscles, whereas in fibromyalgia, there is no inflammation. Both affect the muscles and cause pain that is felt in the muscles. The polymyositis usually causes weakness more than does the fibromyalgia. The fibromyalgia can develop in someone with another inflammatory condition, but there is no inflammation present from the fibromyalgia, which is why the old term for the condition, fibrositis, is not typically used.


The inflammation of the polymyositis is what causes the elevated CPK, which is typically normal in persons with fibromyalgia. Although it is theoretically possible that the fibromyalgia could develop in someone with polymyositis, it would be impossible to make the diagnosis, as the hallmark of fibromyalgia (tender points in muscles) can occur with the polymyositis. If the treatment for polymyositis leads to improvement in other measures of disease, such as the elevated CPK, but the muscle tenderness persists, then there may need to be consideration of whether fibromyalgia also is present.


The usual first-line treatment for polymyositis is steroids, such as the methylprednisolone. The methotrexate is the usual second medicine to be used. It is true that adding a non-steroidal anti-inflammatory medicine to a steroid is generally unwise, because of possible side effects. Using Tylenol is OK, as it works by a different mechanism. Tramadol is also OK, although you had a reaction to it. If the Tylenol is not effective, then the usual approach would be to use a pain medicine, such as codeine or hydrocodone.


Customer: replied 6 years ago.
I am allergic to codeines and synthetic codeines and back when they used to use demerol, it took an AWFUL lot of it to work on me after an open abd surgery in the 70's.. In addition I come from a long line of addicts, so I am loathe to try opioids for a longterm condition. (I don't even drink, although my adult children have an occasional beer or wine without any problems.) So nothing like the nerve meds or anything is likely to help then? I really don't know much about them or their interactions, but I've heard of gabapentin, lyrica and amitryptiline (sp?).

These medicines have been studied in a wide variety of chronic pain syndromes, and appear to help with chronic pain by decreasing the firing of the nerves carrying the pain message. These medicines are not typically used for polymyositis, because the other interventions are usually fairly good are controlling the condition, so managing chronic pain is usually not much of an issue. However, if you are allergic to opiates, then it would be appropriate to consider using one of these agents.


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