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
- Aromatase inhibitors (anastrozole, exemstane, letrozole).
- Corticosteroids
- Prostaglandin derivatives (bimatoprost, latanoprost, travoprost, unoprostone).
- Selective inhibitor of steroid 5α-reductase type II and type III (finasteride).
- Thyrostatic agent (carbimazole).
- Growth hormone (Wh; somatropin; growth hormone, Gh).
- 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 antibodies – imatinib, 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