Muscle Pain (Myalgia): Medical History

Medical history (history of illness) represents an important component in the diagnosis of myalgia (muscle pain). Family history

  • Is there a family history of muscle or neurologic disorders?

Social history

Current medical history/systemic history (somatic and psychological complaints).

  • How long has the pain been present? Has the pain changed? Become stronger?
  • Where exactly is the pain localized (local/diffuse (generalized)? Does the pain radiate?
  • What is the character of the pain? Stabbing, dull, etc.?
  • Is the pain dependent on breathing?
  • Does the pain intensify or get better with exertion/movement?
  • When does the pain occur? Are you dependent on external factors such as stress, weather?
  • Do other symptoms occur in addition to muscle pain?
  • Have you had an infection recently?

Vegetative anamnesis including nutritional anamnesis.

  • Do you drink alcohol? If so, what drink(s) and how many glasses per day?
  • Do you use drugs? If yes, what drugs and how often per day or per week?

Self history incl. medication history.

  • Pre-existing conditions (infectious diseases; metabolic diseases; nervous diseases).
  • Operations
  • Allergies

Medication history

  • Antiarrhythmic drug (amiodarone)
  • Antibiotic
    • Penicillin
    • Sulfonamides
  • Antiepileptic drug (phenytoin)
  • Antihypertensive (enalapril, labetalol).
  • Antimalarials (artemether, chloroquine, hydroxychloroquine, lumefantrine).
  • Antifungals
    • Allylamines (terbinafine)
  • Antiparkinsonian drugs (levodopa)
  • Antiprotozoal agents
    • Analogue of the azo dye trypan blue (suramin).
  • Antiretroviral drugs
  • Arsenic trioxide
  • Beta blocker (metoprolol)
  • Β2-sympathomimetic (salbutamol)
  • Calcimimetic (etelcalcetide)
  • Chelating agent (deferasirox, deferoxamine, D-penicillamine, deferiprone).
  • Fibrates
  • Gout agents (colchicine)
  • Hormones
  • H2 antihistamines (H2 receptor antagonists, H2 antagonists, histamine H2 receptor anatgonists) – cimetidine, famotidine, lafutidine, nizatidine, ranitidine, roxatidine.
  • Immunomodulator (tacrolism)
  • Immunosuppressive (cyclosporine)
  • Immunotherapeutics (interferon α)
  • Lipid-lowering agents
    • Cholesterol absorption inhibitor – ezetimibe
    • Fibrin acid derivatives (fibrates) – bezafibrate, clofibrate, fenofibrate, gemfibrozil
    • HMG-CoA reductase inhibitors (hydroxy-methyl-glutaryl-coenzyme A reductase inhibitors; Statins) – atorvastatin, cerivastatin, fluvastatin, lovastatin, mevastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin) more commonly cause rhabdomyolysis (dissolution of striated muscle fibers/skeletal muscle as well as cardiac muscle) in combination with fibrates, ciclosporin (cyclosporin A), macrolides, or azole antifungals; Furthermore, statins lead to a decrease in endogenous coenzyme Q10 synthesis; frequency of myalgia in clinical practice is 10% to 20%The term statin myopathy is used when:
      • Symptoms occur within four weeks of starting statin use
      • They remit within four weeks after discontinuation of the drug, and
      • Recur upon re-exposure.

      There meanwhile also studies (double-blind randomized and open non-randomized) that attributed statin-associated muscle symptoms to a nocebo effect.The likelihood of statin intolerance is increased if patients had two copies of the LILBR5 gene variants Asp247Gly (homozygous): Probability of CK increase was increased almost 1.81-fold (odds ratio [OR]: 1.81; 95% confidence interval ranged from 1.34 to 2.45), and that of intolerance was increased 1.36-fold even at low statin doses (OR: 1.36; 95% confidence interval ranged from 1.07 to 1.73; p = 0.013)Genetic risk dependent on gene polymorphisms:

      • Genes/SNPs (single nucleotide polymorphism):
        • Genes: SLCO1B1
        • SNP: rs4149056 in the gene SLCO1B1
          • Allele constellation: CT (5-fold risk of myopathy with statin administration).
          • Allele constellation: CC (17-fold risk of myopathy with statin addition).

      Note: The following drugs/substances increase the risk of myalgias/myopathies with statins: Danazol; fibrates; HIV-1 protease inhibitors (indinavir, amprenavir, saquinavir, nelfinavir, ritonavir); itraconazole, ketoconazole; cyclosporine; fibrates; HIV-1 protease inhibitors (indinavir, amprenavir, saquinavir, nelfinavir, ritonavir); Macrolide antibiotics (erythromycin, telithromycin, clarithromycin); nefazodone; verapamil; amiodarone; niacin (> 1 g); grapefruit preparations (There is no claim to completeness! )

  • Lithium
  • Monoclonal antibodiesimatinib, pertuzumab, trastuzumab.
  • Narcotic (propofol)
  • Opioid antagonists (nalmefene, naltrexone).
  • Phosphodiesterase-5 inhibitors/PDE5 inhibitors (avanafil, sildenafil, tadalafil, vardenafil).
  • Proton pump inhibitors (proton pump inhibitors, PPI, acid blockers).
  • Retionoids (acitretin, alitretinoin).
  • Selective prostacyclin IP receptor agonists (selexipag).
  • Antiviral (interferon alpha).
  • Cytostatic drug
    • Antimetabolites (methotrexate (MTX))
    • Hydroxyurea
    • Taxanes (paclitaxel)
    • Vincristine
    • Other cytostatic drugs (vincristine)

Environmental pollution – intoxications (poisoning).

  • Alcohol intoxication
  • Ciguatera intoxication; tropical fish poisoning with ciguatoxin (CTX); clinical picture: diarrhea (after hours), neurological symptoms (paresthesias, numbness of mouth and tongue; cold pain on bathing) (after one day; persist for long to years).
  • Heroin intoxication
  • Cocaine intoxication