Understanding Myalgias

Pain is generally an unwelcome sensation. In medicine, the location, quality, and severity of pain are used to diagnose and treat underlying diseases. Sometimes the diagnosis is obvious, such as a severe bone fracture. However in some cases, all of medical science can only guess at the cause. One type of poorly understood pain is myalgia, otherwise known as muscle pain. The spectrum of illnesses that present with this chief complaint can have many sources: exercise, infection, drugs, hormones, immune-mediated, psychiatric, or perhaps a yet-to-be classified illness.

There are common causes of myalgias that are frequently overlooked by society. Many of these are temporary and do not lead to any long-term problems. For example, the muscle aches that result from viral syndrome are a key symptom to differentiate the flu from a common cold. This myalgia is part of the body’s inflammatory response to foreign germs invading the body. The treatment may vary from over the counter (OTC) to prescription drugs. Myalgia resulting from premenstrual syndrome is similar. In this case, the inflammation is a response to the female monthly menstrual cycle. The inflammation is similar to that experienced in flu-like viral syndromes, which is why it may feel the same.

Another common cause would be exercise-induced myalgia. Many of us experienced this when new-year’s resolutions inspired us to hit the gym, in some cases to excess. Although severe pain or pain associated with dark or red/brown urine should be evaluated urgently by your health care provider most of us take an OTC anti-inflammatory, rehydrate with water, and rest (some until next January!).

The above sources of myalgia can be self-treated, often without professional medical advice. However, if it is the first time that a patient experiences these problems, consultation may help to avoid possible dangerous side effects of some OTCs or potential complications of the condition itself. Once a successful treatment regimen has been established (say for PMS), self treatment of subsequent episodes is generally safe.

Other causes of myalgia can be less obvious. Commonly they can be paired with sleep disturbances, anxiety, and feelings of guilt. Did the patient overspend on the wrong mattress? Could he/she be suffering from an underlying depressive disorder? Only a trained healthcare provider should make these diagnoses. The public and healthcare professionals are shedding the stigma and stereotypes associated with depression. In the recent past, pain was not one of the required criteria for the diagnosis of depression. Today, pharmaceutical companies are spending billions to research and develop medications such as the SNRIs (Effexor, Cymbalta) to treat this sub-type of the disorder. Although some symptoms can be helped with regular exercise and professional psychiatric therapy without a physician, anti-depressant medications should never be tested or used without strict medical supervision.

A less common, but increasingly prevalent myalgia-causing condition is fibromyalgia. This relatively new syndrome, or group of associated symptoms, is often steeped in controversy. Some have criticized it as a fictitious disorder. However, this illness can hurt patients. Undiagnosed, it can burden the healthcare system financially by causing multiple visits to physicians and emergency rooms. The presenting complaints and physical findings are complex, but too similar between patients to be discounted. Several treatments including the neuropathic medication Lyrica and the newer NSRI Savella have been used.

In some situations, the body’s own defensive army (the immune system) turns on itself, creating autoimmune diseases. They include the commonly known Lupus and the lesser known myosites that can plague patients of any age. These illnesses are broad, ranging in both symptoms and prognosis. The myalgias here would likely be long-standing (>2 weeks) with rash, weakness, loss of muscle mass, tenderness, or even fever.

Myalgias can also result from a hormone imbalance as in thyroid disease or vitamin B12 deficiency. These autoimmune, hormonal, psychiatric, and neuropathic causes of myalgia are the reasons for healthcare providers to diagnosis underlying muscle pain, especially if they cannot be attributed to a recent illness or are associated with unexplained changes in strength, mental status, urinary changes, or rashes. These symptoms could indicate potentially organ-threatening diseases that must be managed. Finally, many medications, such as anti-cholesterols, antibiotics, and antifungals, are known to cause unintended muscle breakdown that stops when the medication is stopped. Healthcare providers calculate this risk each time a prescription is written. Although there is some evidence to indicate Coenzyme Q10 (CoQ10) supplementation may help, strong evidence is lacking at this time. Most providers will stop or change the offending agent.

Myalgias are a broad topic with many different causes and treatment options. Although usually not serious, a visit to a healthcare provider is sometimes needed. If in doubt, call your physician for guidance.

Atul Devani, M.D., is a resident physician at Memorial Health University Physicians -- Family Medicine Center located at 1107 East 66th Street, Savannah, Georgia, 31404. He may be reached at 912-350-8404. This article first appeared in Savannah Health Perspective, volume 6, issue 2.