Myalgia

What is Myalgia?

Myalgia  (Myalgias) is defined as muscle pain including a dull aching sensation in the muscle. It is a very common symptom and is part of many disorders and syndromes. The pain can occur anywhere in the body as muscles are present everywhere in the body. The pain can develop in the arms, legs, back, neck and shoulders. The pain ranges from dull aching to severe and excruciating. Almost all these pains go away in a few days. But, sometimes they can last for a few months especially if accompanied with joint pain. They are named and classified according to the location where they occur. Muscle pains are of two major types:

• Sporadic and quick pain
• Steady and deep pain

Most of these pains no matter what the type tend to go away on their own. Sometimes the pain can last for months and be associated with joint pains. It can also be a cause of chronic fatigue in the person.

Myalgia Types

Muscles are present in all parts of the body so the myalgia can occur anywhere in the body. There are certain types that have been defined based on the parts affected and the number of muscles involved. They are:

1. Epidemic Myalgia

This type of myalgia is called Bornholm disease. It affects the muscles of the upper abdomen and the lower part of the chest. The causative agent is viral. The pain is always sudden and spasmodic in nature. It increases with respiration as the muscles of the chest wall move with every breath.

2. Fibromyalgia

Fibromyalgia affects joints, muscles and ligaments and is more widespread in terms of the pain. The pain is a dull aching in nature and can be felt over the entire back. The pain has a psychosomatic aetiologia and is more common in females. It is associated with symptoms like irritable bowel syndrome, insomnia, osteoarthritis, lupus etc.

3. Trapezius myalgia

This type of myalgia involves the muscles of the neck and affects the trapezius muscle. It is long lasting. The pain is increases by repetitive neck movements and stress. It is most common in females. Also, people working for long hours at the computer keeping their neck stiff in one position.

(4) Polymyalgia rheumatic

Polymyalgia rheumatica is basically a type of myalgia that involves many muscles. It is an inflammatory disorder that affects people of older age, above the age of 50. The pain is often associated with stiffness. There is also inflammation in the muscles of the neck, shoulders, upper back, arms, hips and buttocks.

Causes of Myalgia

The onset and history of the pain can help to pinpoint the cause of the muscle pain. Most common reasons are overstretching of the muscle.

1. Strain:

The muscles have a property of stretching and relaxing so there can be pain if there is too much tension in the muscles. Excessive physical activity like gym exercise and weight lifting are common causes. Heavy physical work or exercise can also lead to a tear in the muscle fibers leading to sudden onset of severe pain.

2. Infections:

Infection of the soft tissue surrounding the muscle or inflammatory conditions of the joint can lead to muscle pain

3. Medical Conditions:

There are certain medical conditions where the primary feature is muscle ache. Some of them are:

1. Fibromyalgia – It is a very common problem these days and is known to have a psychosomatic origin. Lack of sleep, stress, fatigue and depression are some of the symptoms that characterize fibromyalgia. It is seen more often in females than in males. It is mostly relieved by physiotherapy and relaxation methods.
2. Myofascial pain syndrome- It is a chronic pain disorder where the pain is felt in certain parts of the body without any other underlying pathology. It is a chronic type of pain disorder. It is best treated with physiotherapy.
3. SLE-Lupus is an autoimmune disorder that affects the immune system and attacks multiple tissues and organs of the body. In this disease, the immune system attacks the cells of the tissues and organs. It is difficult to diagnose and there is no cure for it. Medications are given for controlling the symptoms and to provide relief to the patient.
4. Polymyositis- It is an inflammatory disease that weakens the muscles of the body. It leads to difficulty in doing daily activities like climbing stairs, rising from a sitting posture, holding things in both hands, lifting weights etc. There is no cure for muscle paresis and pain caused by polio but the recent vaccinations have made the disease occurrence rare. It is nearing eradication due to the strict and compulsory vaccination schedule.
5. Viral infections like flu and polio also have effects on muscles and cause muscle pains.

4. Metabolic disorders:

Hypothyroidism or hyperthyroidism are metabolic disorders where the body produces too much or too little of the thyroid hormone leading to systemic symptoms like muscle pain and others. The primary treatment is to use of synthetic hormones.

Hypokalaemia is a condition of low potassium in the body. Potassium is a very important element of the body for good muscle contractions. It is crucial for the cardiac muscles and nerve cells. Patients with potassium lower than 2.5 millimoles per liter have typical muscle pain along with other systemic symptoms.

5. Dermatomyositis:

It is a rare inflammatory disorder with symptoms of muscle pain associated with a skin rash. It is known to affect both children and adults. The skin rash can improve with treatment but there is no cure for the disease.

6. Chronic fatigue syndrome:

It is a complicated disorder characterized by extreme fatigue that is chronic in nature. The fatigue tends to get worse with physical exertion and is not relieved by rest. The cause behind it is still not known.

7. Chronic exertional compartment syndrome:

This is basically an exercise induced condition affecting the muscles and nerves. It leads to pain, inflammation and at times disability of the affected muscles. This condition is seen often in athletes.

8. Claudication:

Claudication is described as muscle pain occurring due to very little blood supply to the part of the body during exercise. This condition affects the legs and occasionally the arms too. The pain comes on during exercise and if the condition worsens, it can be present even at rest. It is a symptom of peripheral artery disease and is treatable.

9. Dystonia:

Dystonia is a muscle disorder. The affected group of muscles contract repetitively and involuntarily causing jerky involuntary movements. The condition can range from mild, moderate to severe. There is no cure for dystonia but medications and surgery can be used to control the symptoms.

10. Lyme disease:

This is a disease caused by four species of bacteria- Borrelia burgdorferi and Borrelia mayonii are the causative agents in United states of America. Borrelia afzelii and Borrelia garinii bacteria cause Lyme disease in Europe and Asia. The symptoms resemble flu and are associated with a rash.

11. Rheumatoid arthritis:

It is an autoimmune disorder where the immune system attacks your own tissues and organs. This arthritis affects the joint and causes inflammation. The surrounding muscles are also affected and it can lead to bone erosion or joint deformity.

12. Rocky mountain spotted fever
13. Muscle cramps that occur after long hours of physical exertion and tend to go away on their own.
14. Repetitive strain injuries.

Myalgia Symptoms

1. Muscle pain: This is the most common symptom and the typical nature of the pain is:

• Dull aching or excruciating pain
• Localized over a particular area
• Lasts for a few minutes
• May heal spontaneously in a few days.
• Mild or severe in intensity

2. Tiredness and fatigue with a decreased desire to do daily activities.
3. Swelling
4. Redness of the affected part
5. Associated joint pain along with the muscle pain
6. Tenderness on pressing the affected muscle.
7. Fever with chills if there is an associated infection
8. Tenderness in muscles
9. Feeling of depression if the pain is chronic in nature.

Myalgia Diagnosis

The diagnosis of muscle pain is difficult, as it is part of so many disorders and syndromes. The diagnosis is reached by proper history taking. The doctor will need to know the following details of the pain. So, you should be observant and give the details and modalities of the pain to the doctor. The following information will help to reach the correct diagnosis.

• Onset-when did the pain first start?
• Type of pain-sharp or dull pain?
• Intensity is generally measured on a scale of 1-10 to assess the severity.
• Spread to other parts of the body- Whether the pain radiates or spreads to other parts of the body?
• Duration and frequency of pain- How long does a pain episode last? How frequently does it occur?
• Effect of activity on the pain-what activities lead to the pain?

In most cases, the history gives a fair idea of the cause of the pain. Investigations that may be needed to confirm the diagnosis and pinpoint the medical condition behind it are: X-rays, CT scan and MRI. Blood tests are not of much importance here. The source of the pain could also be a simple flu or a side effect of chemotherapy.

Myalgia Treatment

Muscle pains respond well to home treatments. Here are a few things that will help you.

1. Rest: Provide adequate rest to the affected areas. If the joint is also affected then use a crepe bandage or support to provide stability to the joint and surrounding muscles.
2. Medications: Painkillers and anti inflammatory medicines can be used to get symptomatic relief.
3. Ice and Heat: Applying ice packs and hot water bags help to reduce the localized pain and inflammation.
4. Gentle muscle stretching provides relief from the pain. However, be careful not to apply too much pressure as you can cause over stretching of the muscle.
5. Restrain: Avoid very heavy exercises and heavy physical activity till the muscle pain goes away.
6. Elevating the affected joint or part and providing adequate support also helps to reduce the pain as the swelling tends to go down.
7. Acupuncture and alternate therapies like homeopathy are also very effective in treating the muscle pain.
8. Reduce the stress by yoga, meditation and massage.
9. Warm bath or applying slightly hot water also provides relief from the pain.
10. If the pain does not get better after few weeks, has accompanying symptoms and is very severe, then you must see the doctor.
11. Medical treatment: Depending on your symptoms, you may need symptomatic medications.

a)Antibiotics: If the muscle pain is due to an underlying infection. It is important that you complete the entire duration of the medicines and do not stop it halfway.

b) Corticosteroids: They are mainly used to reduce the inflammation.

c) Antidepressants: in patients with chronic pain or psychosomatic illness like fibromyalgia.

d)Pain medications: They provide symptomatic relief by blocking the pain receptors in the central nervous system. Ibuprofen and naproxene sodium are used commonly to get relief from muscle pain.

When you should see the doctor:

Generally, muscle pain goes away on its own. But, if the pain seems to persist then there could be a bigger underlying problem. If you notice the following symptoms along with the muscle pain then you should see the doctor immediately.

• No improvement in pain even after trying the above measures
• Severe muscle pain
• Rash along with the muscle pain
• Fever and chills with the pain
• Nausea and vomiting
• Inability to move certain parts of the body
• Weakness and paresis of any of the limbs
• Difficulty in breathing
• Sudden pain after a change in the medication

Tips for Prevention of Muscle Pain

If the muscle pain is due to physical activity, then you must do warm up stretching exercises before beginning a work out. This helps to prevent muscle strain. Drink plenty of water. If you have a job where you sit for long hours, then you must stretch out every few hours to keep muscle pain away. Do your exercises in moderation and avoid very heavy weight lifting.