Friday Q&A: Statins & muscle aches; when is pain “normal”?; opioids for rheumatoid arthritis; & chronic pain

Your questions about pain management 💊

ICYMI

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Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.

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QUESTION #1

I am 53 and was put on a statin for my cholesterol and my whole body feels like it has arthritis! My internist just took me off to see if this was the cause (my bloodwork did not show inflammation or other red flags). What about the shots that you can take every two weeks for high cholesterol? I don’t want to have a heart attack as I lost my father when he was 52. It feels like whack a mole, cholesterol numbers good, body not, off the meds body good, cholesterol not so much!

- Jenny

Dear Jenny,

I hear you! Everything in medicine is a balancing act; treating high cholesterol is no exception. Statin-induced muscle aches can range from mild discomfort to severe muscle inflammation. Some of the risk factors include higher statin doses, advanced age, being female, previous muscle-related side effects, and a family history of statin-related muscle aches.

Photo by Towfiqu barbhuiya on Unsplash

But be careful not to attribute every ache and pain to your statin drug! I commonly see patients whose skeletal woes stem from mechanical issues (like arthritis or a bum knee), not Lipitor. As always, it’s important to discuss any potential medication side effects with your doctor.

Here are some things I consider with my own patients once it is clear that their symptoms are due to statins:

• Medication adjustments. Sometimes a lower dose achieves a better balance between cholesterol management and muscle discomfort. Sometimes simply switching to a different statin makes a difference. For example, Pravastatin tends to be less likely to cause muscle aches that other statins (however it is a “weaker” statin).

• Consider other medications. Sometimes muscle aches stem from the combination of various prescription medications, alcohol and other substances—or from other medications altogether. Make sure to review everything you take—medications, supplements, vitamins, and all other substances you ingest—with your doctor.  

• Healthy habits. Regular exercise, a balanced diet, and adequate hydration can sometimes offset muscle aches due to statins.

• Coenzyme Q10 (aka “CoQ10”) supplementation. Some studies suggest that statins might deplete CoQ10 levels in the body, leading to muscle-related side effects. I often prescribe CoQ10 supplements to address this potential deficiency.

• Repatha (evolocumab) is a relatively new drug—a twice-monthly shot for certain patients who are unable to tolerate statins. It is also used for people who have a poor response to statins and/or who have very high cholesterol due to genetic factors.

It's important to note that while muscle aches are a potential side effect of statins, the benefits of statin therapy in reducing the risk of cardiovascular events like heart attacks and strokes can be significant, depending on the patient’s health profile and specific risks. Each person's situation is unique, so it's crucial to consult with your own healthcare provider for nuanced advice about any and all medications.

I hope that helps! 

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QUESTION #2

In a previous podcast, you talked about the importance of listening to your body. My question is, how can you distinguish between normal aches and pains that are just part of getting older, and a more serious concern that requires medical attention?

- JG