Statin induced muscle pain mostly isn't a thing ....

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Eddy Edson

Eddy Edson

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Relationship to Diabetes
Type 2
according to yet another large meta study.


Background​

Statin therapy is effective for the prevention of atherosclerotic cardiovascular disease and is widely prescribed, but there are persisting concerns that statin therapy might frequently cause muscle pain or weakness. We aimed to address these through an individual participant data meta-analysis of all recorded adverse muscle events in large, long-term, randomised, double-blind trials of statin therapy.

Methods​

Randomised trials of statin therapy were eligible if they aimed to recruit at least 1000 participants with a scheduled treatment duration of at least 2 years, and involved a double-blind comparison of statin versus placebo or of a more intensive versus a less intensive statin regimen. We analysed individual participant data from 19 double-blind trials of statin versus placebo (n=123 940) and four double-blind trials of a more intensive versus a less intensive statin regimen (n=30 724). Standard inverse-variance-weighted meta-analyses of the effects on muscle outcomes were conducted according to a prespecified protocol.

Findings​

Among 19 placebo-controlled trials (mean age 63 years [SD 8], with 34 533 [27·9%] women, 59 610 [48·1%] participants with previous vascular disease, and 22 925 [18·5%] participants with diabetes), during a weighted average median follow-up of 4·3 years, 16 835 (27·1%) allocated statin versus 16 446 (26·6%) allocated placebo reported muscle pain or weakness (rate ratio [RR] 1·03; 95% CI 1·01–1·06). During year 1, statin therapy produced a 7% relative increase in muscle pain or weakness (1·07; 1·04–1·10), corresponding to an absolute excess rate of 11 (6–16) events per 1000 person-years, which indicates that only one in 15 ([1·07–1·00]/1·07) of these muscle-related reports by participants allocated to statin therapy were actually due to the statin. After year 1, there was no significant excess in first reports of muscle pain or weakness (0·99; 0·96–1·02). For all years combined, more intensive statin regimens (ie, 40–80 mg atorvastatin or 20–40 mg rosuvastatin once per day) yielded a higher RR than less intensive or moderate-intensity regimens (1·08 [1·04–1·13] vs 1·03 [1·00–1·05]) compared with placebo, and a small excess was present (1·05 [0·99–1·12]) for more intensive regimens after year 1. There was no clear evidence that the RR differed for different statins, or in different clinical circumstances. Statin therapy yielded a small, clinically insignificant increase in median creatine kinase values of approximately 0·02 times the upper limit of normal.

Interpretation​

Statin therapy caused a small excess of mostly mild muscle pain. Most (>90%) of all reports of muscle symptoms by participants allocated statin therapy were not due to the statin. The small risks of muscle symptoms are much lower than the known cardiovascular benefits. There is a need to review the clinical management of muscle symptoms in patients taking a statin.
 
Nice to know how unique I am!! Taken off statins after 18 months of trying, with the worst side effects seen by my GP. Not just severe pain but many other even more unpleasant side effects.
 
Was definitely a thing for me. Had to start driving/getting the bus to places I’d normally walk to as I wasn’t capable of walking the pain was that bad
 
and me
 
I couldn't live with the pain, so I stopped taking them. They can do as many surveys / as much research as they like. The bottom line for me is: I developed pain when I was taking statins, I stopped taking them and the pain stopped too. Judging by comments on this forum, it happens. My mum had the same experience. I think there's one more statin I can try, so I'll give it a go if needs be. 🙂
 
I had pains in my forearms and shins when I started taking statins just after I was diagnosed, and they stopped when I stopped taking them….BUT… I didn’t know at the time about transient neuropathy when your blood sugars start to fall, (and mine had been mega high for months) so I’m prepared to admit they were coincidental. I’ve recently started statins again, because my cholesterol had gone up a bit, and I haven’t got any aches and pains (except for normal ones after exercising at my age!) However, the jury is still out on the fact that my insulin needs suddenly increased, and I’ve just got early signs of a cataract. Again, maybe coincidence, maybe not, I shall never know.
 
If it was down to been older, as the media reporting today, how come 15 years of stopping them,I am not getting the pains I wad getting whilst on them!
 
Not to mention the decline in cognitive function that I and several other people I know had. Back to normal once I ditched the darn things.
 
Heard this all over radio news yesterday, hopefully it will persuade those who most need them to take them.

Only took statin for 3 months, didn't have any side effects & didn't expect to as most folk don't, as evident by this research statins must be one of the most researched drugs around in modern times & considered safe.
 
Pattidevans said:
Not to mention the decline in cognitive function that I and several other people I know had. Back to normal once I ditched the darn things.
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Within 2 days of starting them, my friend was found wandering round the next village in a confused state with no idea how she got there. It took me 9 months to get back to normal after I stopped them, but the side effects had been building up for 18 months, getting worse all the time. I was tried on 3 different ones, each as bad as the other.
 
It was 18 months before the last painful muscle subsided, but the damage to my memory was significant.
I have a photo with 'Mother is the one on the right' on the dresser.
 
nonethewiser said:
Heard this all over radio news yesterday, hopefully it will persuade those who most need them to take them.

Only took statin for 3 months, didn't have any side effects & didn't expect to as most folk don't, as evident by this research statins must be one of the most researched drugs around in modern times & considered safe.
Click to expand...
Hopefully will also help to persuade GP's to be less statin-hesitant. Studies show big under-prescribing versus guidelines, partly due to largely unwarranted concern re side effects.

You can see how that can happen: GP's will see a significant number of patients on statins with muscle pains which go away when the statin is dropped.

There's no way for the GP to know that this is actually nocebo effect, as it usually is - ie that the patients would get the same muscle pain from a placebo if they thought it was a statin.

So the GP gets gun-shy about statins & underprescribes versus guideline dosages & also through his/her words reinforces the nocebo effect.

Sets up a crappy cycle between message board & media anecdotes and GP surgery ...
 
We understand so little about how nocebo and placebo effects work unfortunately. :(

Placebo improvements in symptoms are real and have been measured in studies if i remember right. Plus they are scalable - people get more improvement if the therapy is more ‘medically’ (eg bigger dose, or injection vs tablet).

Nocebo pain is just as real and unpleasant as any other I’d imagine.

I’m not sure how much work has been done on how to reduce nocebo effects?
 
The human body is an amazing machine and it produces cholesterol for a purpose, we know so little about interfering with chemicals and I feel we should not "blanket" prescribe any drugs whatsoever. The cognitive function interference is well documented, after all cholesterol is a building block for every cell in the body, in particular brain cells. So I regret @Eddy Edson I must disagree with you that these drugs should be distributed like sweeties.
 
Every year I am encouraged to go back on the tablets, and to try different ones.
I just tell them about the photo on the dresser with the note on the back to tell me which one is my mother. They go a bit quiet then.
I can tell them about the screaming muscles and aching joints until I get hoarse from anxiety, thanks to studies which show it was all in my mind.
 
Eddy Edson said:
Hopefully will also help to persuade GP's to be less statin-hesitant. Studies show big under-prescribing versus guidelines, partly due to largely unwarranted concern re side effects.

You can see how that can happen: GP's will see a significant number of patients on statins with muscle pains which go away when the statin is dropped.

There's no way for the GP to know that this is actually nocebo effect, as it usually is - ie that the patients would get the same muscle pain from a placebo if they thought it was a statin.

So the GP gets gun-shy about statins & underprescribes versus guideline dosages & also through his/her words reinforces the nocebo effect.

Sets up a crappy cycle between message board & media anecdotes and GP surgery ...
Click to expand...

Totally agree Eddie, this research is welcome in that respect.
 
WELL NOW WE NO over the last 20years or more over 3 main DOCTORS I Have tried and failed convince me to take them no no no
insulin is absorbed by muscle action , i have known people to take all complain of aches and pain all be linked to THE S WORD
PS and in todays news LYPMPHONY all types the person suggested to see the DOCTOR LAST YEAR
I TRIED IN GREAT PAIN 3 DAYS UNABLE to do this because of COVID so off to A E 43 DAYS IN AND OUT HOSPITAL 2 major opps 8 sessions of KEMO all clear APRIL now owe 2 million plus TO OUR GREAT NHS Many thank s to staff Nurses Docs cleaners tea lunch vic
 
everydayupsanddowns said:
Placebo improvements in symptoms are real and have been measured in studies if i remember right. Plus they are scalable - people get more improvement if the therapy is more ‘medically’ (eg bigger dose, or injection vs tablet).

Nocebo pain is just as real and unpleasant as any other I’d imagine.

I’m not sure how much work has been done on how to reduce nocebo effects?
Click to expand...
Or to increase placebo effects. It is known that placebos can work (to some extent) even when people know that they're taking a placebo. So just knowing that what you're feeling is likely (or certainly) nocebo probably isn't sufficient.

This page suggests "There has been little work published on examining how the nocebo effect can be reduced." but continues to offer some suggestions.

The nocebo effect: what is it, why is it important and how can it be reduced? - bpacnz

bpac.org.nz bpac.org.nz
 
Thanks @Bruce Stephens

I’m a couple of weeks into Atorvastatin, and so far so nothing to speak of. Fingers crossed it stays that way!
 
everydayupsanddowns said:
We understand so little about how nocebo and placebo effects work unfortunately. :(

Placebo improvements in symptoms are real and have been measured in studies if i remember right. Plus they are scalable - people get more improvement if the therapy is more ‘medically’ (eg bigger dose, or injection vs tablet).

Nocebo pain is just as real and unpleasant as any other I’d imagine.

I’m not sure how much work has been done on how to reduce nocebo effects?
Click to expand...
Interestingly the placebo effect even works on babies. The generally prevailing theory is that parent/carer is calmed/has reduced anxiety by feeling like they’re giving something that helps, which then calms the baby as they pick up on parental/carer mood, thus reducing symptoms like crying and irritability.
 
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