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Is statin myalgia actually a thing?

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

I sure thought it was. Now I don’t know what to think. Thanks a bunch, science!

Some time ago I added “statin myalgia” to my list of surprising sources of pain. Statin myalgia is, allegedly, a muscle pain side effect of cholesterol-lowering drugs like Lipitor and Crestor. But now I may need to walk that back: in a new study designed to test the existence of this phenomenon, taking statins didn’t boost muscle risks in patients when they were unaware that they were taking them. This suggests that statin mylagia is something people get because they are afraid of it, not because it’s a real side effect. As the authors concluded:

These analyses illustrate the so-called nocebo effect, with an excess rate of muscle-related AE reports only when patients and their doctors were aware that statin therapy was being used and not when its use was blinded. These results will help assure both physicians and patients that most AEs associated with statins arenot causally related to use of the drug and should help counter the adverse effect on public health of exaggerated claims about statin-related side-effects.

Everyone loves to hate drugs, and most people don’t even think to question reports of something like statin myalgia. I didn’t! And even with this evidence in front of me, I’m still not sure what to make of it — because it’s not at all difficult to cite evidence that statin myalgia is a real problem. The truth is probably “all of the above” and “it’s complicated” — it seems likely that some patients are genuinely intolerant of statins, while others are suffering from fear of statins and/or some other cause of musculoskeletal pain (of which there are many, of course). There might also be some tricky X-factors, like vitamin D deficiency, which seems to be linked to statin myalgia.

So I don’t know what to think now, and that’s probably how it’s going to stay for a while. But I’ll be digging deeper, looking and more research and asking experts for clarification. … For now, wherever I mention statin myalgia on, I have also highlighted the controversy and cited this new study.