With and Without: Rheumatoid Arthritis and Fibromyalgia Pain

Explaining the difference between rheumatoid arthritis (RA) pain and fibromyalgia pain isn’t easy. Articulating what pain feels like is extremely difficult to begin with, adding an attempt to differentiate different kinds of pain is even more of a challenge.

I have both RA and Fibro, the latter adding on to the party in 2004. Fibro is what taught me to refer to pain as being ‘loud.’ RA pain is deep and interior, and can leave you curled up in a fetal position, not wanting to move ever again. Fibromyalgia pain can be white static that makes it impossible to focus, and can feel like somebody is blaring a fire alarm in your ear for hours.

But still, does that tell you anything about the pain itself?

I have recently had occasion to do some in-person research. I can tell you that both can involve throbbing, but that’s where the similarities end.

A bit of back story

As have been evident from my repeated whining of late, I’ve had quite a humdinger of a cold for about a month. Because of this, I didn’t take my biologic for about the same amount of time. And really surprisingly, I wasn’t feeling it. In the past, I might’ve been able to skip one cycle, but then I start feeling a change. Nothing big, but pain and that soggy feeling so unique to RA would start to encroach around the edges.

This time, nothing. I was fine. There was even a moment when I considered if I might have become one of those people that we hear about in the myths who can stop their biologic and remain fine.

Yeah, that was too much to ask for.

RA makes a visit

I saw my doctor on a Monday, and was still too sniffly and cough-y for either of us to be comfortable with adding an immunosuppressant to the mix. And I was fine, so really, there was nothing to worry about.

I should stop saying these things out loud.

The next day something interesting happened. After stepping away from the computer to have lunch, a tendon in my right forearm was in a lot of pain. And not Fibro pain. This was different. This was Serious, intense, and deep. I was a little alarmed. It felt familiar. It felt RA-ish.

But then it went away, so I stopped worrying.

Until that evening, when the snow started coming in. I respond poorly to barometric changes, it always brings pain of one kind or another, and quite substantially so.

When I went to bed, I couldn’t sleep because of the throbbing in my feet. My toes were especially affected, and I paid a bit of attention to them.

The pain was in the bones, the joints, and especially the base joints in the toes on each foot, I could feel all ten of them throbbing with the rhythm of my heart. Each throb filled the space in the joints, pushing up against the boundaries, trying to expand. It had that deep feeling again, echoes of sound waves at the floor of the ocean.

RA. Without a doubt. Instant panic.

I woke up feeling fine the next morning, but nonetheless made an appointment to get my shot as soon as possible. I’d call that throbbing a shot across the bow. No need to wait for the full onslaught.

The fibro side of things

Thankfully, the shot worked beautifully. The RA withdrew, scuttling back into its cave with a final glare across its shoulders, and a low snarl.

And then the weather changed, as it tends to do at this time of the year. And I found myself in a similar situation, lying in bed in the dark, sleep held at bay by pain.

My feet were throbbing again, especially the forefoot and the toes. I closed my eyes and paid attention, thinking I might as well make productive use of the time and try to compare this pain to the other.

It took a while. This pain was hard to parse, encompassing all of the foot. I tried to listen to the bones and the joints, but it was hard to penetrate this buzzing throb. A throb, by the way, that didn’t have that direct line to the beat of my heart that the RA throb does.

And then, somehow, it came to me. The throbbing was happening in my skin and soft tissue between the metatarsals. I could feel that v-shape of the tissue between each bone in the foot, as well as the skin surrounding it. I could feel it because it was throbbing and buzzing and stinging and so very present.

But I couldn’t hear the bones. They were a negative space between and surrounded by tissue and skin, a non-feeling, a quiet that didn’t engage with the pain.

That may not tell you much about the pain, as such. It is more a story of its origin, and the origin's influence on the quality of the pain.

How would you describe RA and Fibro pain?