Understanding Polymyalgia Rheumatica (PMR)

Polymyalgia, often referred to as Polymyalgia Rheumatica (PMR), is a medical condition which causes muscle pain and stiffness, typically in the shoulders, neck, hips, and thighs. It primarily affects older adults, mainly those over the age of 50, and is more common in women than in men. PMR can have a significant impact on a person's activity of daily living.

In some cases, muscle pain and stiffness can be a symptom of another underlying secondary condition, such as rheumatoid arthritis or lupus. These cases are often referred to as secondary polymyalgia.

Conditions that mimic Polymyalgia Rheumatica (PMR)

Common Signs and Symptoms of Polymyalgia Rheumatica

Muscle Pain and Stiffness - it occurs in morning lasting for more than 45 minutes or after periods of inactivity.
Shoulder Pain - limited range of motion in the shoulders causing difficulty in overhead activities like combing hair.
Neck Pain - side rotations are difficult to perform.
Gluteal and Thigh Pain: patients find it challenging to stand up from a sitting position, walk, or climb stairs.
Fatigue - experience a general sense of un-wellness, which can impact their energy levels and daily activities.
Generalized Aching - flu-like ache in the muscles and joints is seen.
Fever - a low-grade fever may be present.
Weight Loss - unintended weight loss is sometimes associated with PMR.
Depression and Mood Changes - chronic pain and discomfort can lead to mood changes, including depression and irritability.

Causes of Polymyalgia Rheumatica

Autoimmune Reaction - immune system appears to target the synovium, a membrane that lines the joints, leading to inflammation and pain.
Genetic Predisposition - it makes individuals more susceptible to developing the condition.
Infection – not fully confirmed but it might trigger PMR in genetically susceptible individuals
Age and Gender - affects older adults over the age of 50. It is also more common in women than in men.

Diagnosing Polymyalgia Rheumatica

For a prompt diagnosis of PMR, the following essential criteria must be met:

Age > 50 years
Bilateral shoulder pain
Raised erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)

Further, according to EULAR-/ACR classification criteria for PMR following points are also taken into consideration:

Morning stiffness > 45 minutes
Rheumatoid factor and/or anti-CCP negative
Pain in the pelvic girdle and reduced hip mobility
No other painful joints
Ultrasound findings reveal subdeltoid bursitis, tenosynovitis of the long head of the biceps, and/or glenohumeral joint effusion
Ultrasound of lower limb reveal trochanteric bursitis and/or hip joint effusion

Pain Management Techniques for Polymyalgia Rheumatica

Relaxation Techniques:

Stress can exacerbate pain. Techniques like deep breathing exercises and progressive muscle relaxation like hold-relax technique can help manage stress and reduce pain perception.

Biofeedback:

Biofeedback therapy can teach individuals how to control physiological processes like muscle tension and pain perception.

Electromyography (EMG) Biofeedback for Muscle Tension:

In this technique, the sensors are placed on the skin to measure muscle activity. Patients can see the output or feedback on a screen, which helps them identify tense muscles thus giving them a learning experience on how to to relax specific muscle group. This helps in reducing tension and alleviate conditions like tension headaches or muscle pain.

Thermal Biofeedback for Stress Reduction:

In thermal biofeedback, the sensors help measure skin temperature. Patients are able to see changes in their skin temperature as a response to stress. It helps them manage stress and anxiety.

Surface Electromyography (sEMG) Biofeedback:

This technique gives information on muscle tension associated with pain thus individuals can learn relaxation techniques to reduce muscle tension and reduce pain in conditions like tension headaches or musculoskeletal pain.

Electrotherapy:

Application of hot packs or cold packs (cryotherapy) to affected areas can help relax muscles and reduce stiffness or reduce inflammation during acute flare-ups.

Exercises for Polymyalgia Rheumatica:

The physiotherapist can design a customized exercise program to maintain and improve joint mobility. Gentle range of motion exercises can help reduce stiffness and maintain joint function. Strengthening the muscles around affected joints can help provide better support and stability, reducing pain and improving function.

Patients with PMR are usually on glucocorticoid therapy but there is complete remission of symptoms within 4 weeks. Thus exercises play a crucial role in managing pain and treating its symptoms..

Lifestyle Modifications:

The physiotherapist can guide patient to break tasks into smaller, manageable segments and allowing himself for rest periods which can help conserve energy and reduce pain. Along with it he should ensure proper ergonomics in work and home environment which minimize strain on joints.