Drug-Related Muscular Pain
Kohlstadt Ingrid, Cintron Kenneth in Metabolic Therapies in Orthopedics, Second Edition, 2018
In order to facilitate prompt diagnosis and, where possible, avoidance, this chapter provides an overview of common perpetrators of drug-related muscle pain. Skeletal muscle makes up a large portion of the body’s mass and receives a large amount of blood supply. Due to its metabolic activity, many drugs that enter the body’s circulatory system are passed throughout skeletal muscles leading to various drug-induced disorders. Adverse drug effects on muscle include myalgias, myositis, and rhabdomyolysis. Myalgia is muscle pain that is characterized by diffuse muscle pain, tenderness, and cramps. This can be associated with muscle weakness, but it is not always a characteristic. Myalgia is not accompanied by elevations in creatinine kinase, but symptoms of cramps and aches can be a precursor to more serious conditions such as rhabdomyalgia. Myositis is inflammation of voluntary muscle fibers and is associated with muscle symptoms that are similar to myalgia in addition to elevations in serum creatine kinase (CK). Creatine kinase originates in the myocardium and skeletal muscle. Skeletal muscle accounts for around 94% of creatine kinase, and CK is a marker for muscle damage. Myopathy, which is sometimes used interchangeably with myositis, is a general term for disease of the muscles. It can be either acquired or inherited; inherited forms can occur at birth or have an onset later in adult life. There is a strong correlation between many drugs and the presence of myopathies associated with fatigue, generalized muscle pain, muscle tenderness, muscle weakness, significantly elevated CK > 10 times the upper limit of normal (ULN), nocturnal cramping, and tendon pain. Rhabdomyolysis usually presents as an acute event, but it can have an insidious onset over a period of weeks. Approximately 50% of cases present with pain, but most if not all cases present with muscle weakness, muscle swelling, myoglobinuria, and a marked elevation in serum CK (between 10 and 100 times ULN).
Bones and Joints
A. Sahib El-Radhi in Paediatric Symptom and Sign Sorter, 2019
Acute muscle pain (myalgia) is a common complaint occurring in association with minor trauma, muscle overuse and viral infections. It is not due to systemic or local spread of the microorganisms, but rather due to interleukin-1 effect, which induces protein breakdown (proteolysis). Myalgia can be due to benign causes, such as musculoskeletal injury (sprains, strains, contusions or overuse) or musculoskeletal pain syndrome (MSPS), or to more serious conditions, such as myopathies (e.g. dermatomyositis or polymyositis), metabolic disorders (glycogen storage disease) or muscular dystrophies (e.g. dystrophinopathies including Duchenne muscular dystrophy). Occasionally, myalgia can be recurrent (e.g. familial Mediterranean fever) or chronic (e.g. chronic musculoskeletal pain).
Muscular Pain
Mark T. Kinirons, Harold Ellis in French’s Index of Differential Diagnosis an A–Z, 2016
Several inflammatory disorders of muscle are commonly associated with muscle pain and tenderness, and these should be considered in any patient who complains of myalgia. In polymyositis and dermatomyositis, over 50 per cent of sufferers will describe pain as well as muscle weakness. The pain is usually a deep aching within the muscles, and it is often aggravated by activity. The muscles may be swollen as well as tender. Similar symptoms are seen in a variety of other connective tissue diseases when there is an associated inflammatory myopathy, for example rheumatoid arthritis, Sjögren’s syndrome, systemic lupus erythematosus, polyarteritis nodosa, scleroderma and mixed connective tissue disease. Several epidemics of influenza due to type A or B virus have been described in which there was a rather acute onset of severe myalgia lasting 1 or 2 weeks, with creatine kinase often elevated many times above normal. In Bornholm’s disease, the acute onset of chest and abdominal pain, chiefly at the costal margins and in the subcostal region, is usually the first symptom. Affected muscles are tender to pressure, and pain is induced by muscle contraction. The acute pain and fever last several days, and after initial recovery, one or more relapses are not uncommon. Care must be taken not to confuse one of these relatively benign and reversible syndromes with polymyositis of acute onset. An unusual type of muscle disease may result from eating undercooked pork infected with the larvae of Trichinella spiralis.
Ocular Inflammation Associated with Polymyalgia Rheumatica without Concomitant Giant-Cell Arteritis: A Report of Three Cases
Published in Ocular Immunology and Inflammation, 2018
Takahiro Arai, Rie Tanaka, Toshikatsu Kaburaki
Purpose: We report three cases of ocular inflammation and polymyalgia rheumatica without concomitant giant-cell arteritis. Methods: Report of three cases. Results: Polymyalgia rheumatica onset was at a mean age of 66.7 years, and ocular inflammation, which developed 7–21 months later, was bilateral in all patients. Ocular inflammation presented as episcleritis, scleritis, or anterior uveitis, and it emerged during the tapering of low-dose prednisolone prescribed for polymyalgia rheumatica in all patients. Recurrence of ocular inflammation was observed in two patients. Conclusions: Ocular inflammation associated with polymyalgia rheumatica was often bilateral and occurred during steroid tapering. Although this presentation is relatively uncommon, polymyalgia rheumatica should be considered in the differential diagnosis of older patients presenting with ocular inflammation, especially those with proximal myalgia and elevated inflammatory markers.
Influence of coping strategies on oral health-related quality of life in patients with myalgia
Published in CRANIO®, 2019
Guzin Neda Hasanoglu Erbasar, Cansu Alpaslan
ObjectiveTo identify coping strategies used by patients with myalgia and to assess the influence of pain characteristics and coping attitudes on their oral health-related quality of life (OHRQoL). MethodsOne hundred patients diagnosed with myalgia due to temporomandibular disorders were included in this study. They were administered a three-part questionnaire. For preselecting associated coping variables, correlation analysis was performed between coping strategies and OHRQoL domains. A block-wise hierarchical multiple regression analysis was carried out to evaluate whether coping strategies had any influence on OHRQoL. ResultsNotable trends were found between coping strategies and demographic variables and pain characteristics. OHRQoL appeared to worsen with pain severity and with coping strategies that reveal passive or avoidant attitudes of the patient. DiscussionIndividual coping strategies should be considered while managing myalgia. A multidisciplinary approach that aims to help these patients acquire suitable coping strategies may be useful in improving their OHRQoL.
Rapid resolution of protracted febrile myalgia syndrome with anakinra: Report of two cases
Published in Modern Rheumatology, 2016
Rıdvan Mercan, Aynur Turan, Berivan Bitik, Abdurrahman Tufan, Seminur Haznedaroglu, Berna Goker
Protracted febrile myalgia syndrome (PFMS) is a very rare but severe manifestation of familial Mediterranean fever (FMF) which is characterized by severe debilitating pain in large muscle groups that may last for several weeks. Colchicine is ineffective and treatment is largely supportive. Demonstration of crucial role of interleukin-1 (IL-1) in the pathogenesis of FMF has increased the use of IL-1 blockers in colchicine resistant or intolerant patients. Herein, we reported successful use of an IL-1 inhibitor, anakinra, in treatment of two patients with PFMS.
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