Causes of muscle pain and treatment options.

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Many experience muscle pain, also called myalgia . The most common cause of localized muscle pain is overuse of muscles or an injury (sprain). On the other hand, viral infections like the flu ("flu") can cause systemic muscle pain, as can certain medications or conditions like fibromyalgia or hypothyroidism.

Muscle pain can be felt differently: painful, jerky, stabbing, or burning, depending on what's behind it. Ultimately, determining the cause of muscle pain requires a history, a physical exam, and sometimes blood tests and / or imaging tests. In rare cases, a muscle biopsy is required.

Once diagnosed, your healthcare provider will develop a treatment plan that will hopefully bring you the relief you deserve.

Note. Muscle pain in babies and children can have different causes than in adults; This article focuses on the latter.

Illustration by Alexandra Gordon, Get Meds Info

Causes

Due to the many potential causes of muscle pain, it is easier to divide them into two categories: those associated with localized muscle pain and those that cause systemic muscle pain.

Localized muscle pain

Localized muscle pain refers to focal or localized pain around a muscle or group of muscles.

Muscle tension

A muscle (or group of muscles) can be overloaded, injured, or inflamed as a result of strenuous exercise and / or jerky movements. For example, when suddenly pushing from a jump during a basketball game, an athlete can over-squeeze or tear (overtighten) the gastrocnemius muscle.

Muscle sprains often cause a sudden, sharp, or tearing sensation, sometimes accompanied by swelling or bruising .

Muscle cramps or spasms

A muscle cramp or spasm is a muscle contraction or contraction that is out of your control. A classic example is Charlie's horse, whose calf muscle contracts on its own, causing sudden, severe pain. As soon as the muscle relaxes (usually within a few seconds), the calf often begins to hurt.

It's not clear what exactly causes muscle cramps, but experts suspect there are multiple triggers, such as:

  • Wrong stretch
  • Muscular fatigue
  • Extreme heat sports
  • Dehydration
  • Salt and electrolyte depletion.

Muscle cramps can also occur with a variety of underlying medical conditions, including cirrhosis of the liver and peripheral arterial disease .

Muscle contusion

A muscle injury (hematoma) can result from a direct blow to the muscle, such as a fall on a hard surface or a blow during a sports game. This direct blow (or series of blows) essentially destroys the muscle fibers and surrounding connective tissue.

In addition to muscle pain, the skin around the sore muscle can become inflamed and discolored. Also, a person may feel stiff and weak in the affected area, and in some cases, a hematoma (blood pool) forms around the injured muscle .

Myofascial pain syndrome

Myofascial pain syndrome (MPS) is a pain disorder caused by trigger points within a muscle or group of muscles. These trigger points, which feel like little knots under the skin, are essentially tight muscle groups and / or fasciae (tissue that surrounds the muscles). Trigger points can be painful to the touch and transmit pain to other parts of the body.

Trigger points are usually located in the upper trapezius muscles (located at the back of the neck, above each shoulder). These trapezius trigger points can cause a severe and / or burning headache that is felt in the back or side of the head.

Compartment syndrome

Compartment syndrome is an unusual condition that occurs when pressure builds up within a "compartment" or group of muscles.

There are two types of compartment syndromes :

  • In acute compartment syndrome , muscle pain develops suddenly, is severe, persistent, and is often described as deep pain or burns. Neurological symptoms such as numbness or tingling can also occur with this serious condition.
  • In chronic compartment syndrome, muscle pain occurs gradually during exercise. The classic case is that of a young runner who experiences pain, tightness, tightness or cramps in the lower leg after a certain amount of time running. Unlike acute compartment syndrome, pain in chronic compartment syndrome resolves with rest, usually within 30 minutes.

Pyomyositis

Pyomyositis is a rare, suppurative muscle infection (usually Staphylococcus aureus ) that causes cramps in a group of muscles, most commonly the thigh, calf, or buttock muscles.

As the infection progresses (about two weeks after the cramps appear), a fever often develops and the muscle becomes extremely painful and inflamed. During this time, an abscess (collection of pus) may be visible within the muscle.

If left untreated, the infection can spread to other organs, such as the heart, lungs, and brain .

Systemic muscle pain

Systemic muscle pain felt throughout the body is often associated with infections, drug side effects, or an underlying medical condition.

Infection

Certain types of infections, especially viral infections, can cause muscle pain. Perhaps the most common infectious cause is influenza , commonly known as the "flu."

In addition to diffuse muscle or body pain, other potential flu symptoms include fever / fever, chills, headache, cough, sore throat, runny / stuffy nose, and unusual tiredness. Vomiting and / or diarrhea can also occur, although this is more common in children than adults.

Other infections that can cause muscle pain include :

Medicine

One of the common medications that can cause mild to moderate muscle pain and weakness as a side effect is statins , which are used to lower cholesterol levels. If you develop muscle pain while taking a statin, it usually starts within six months of starting the drug and goes away in about two months (on average) after you stop taking the drug .

Besides statins, other medications associated with muscle pain include:

Fibromyalgia

Fibromyalgia is a chronic pain disorder that causes widespread muscle pain, often described as painful, intense, burning, or stabbing.

In addition to muscle pain, people with fibromyalgia may also experience trouble sleeping, fatigue, headache, tingling, morning stiffness, mental confusion, and anxiety .

Myalgic encephalomyelitis / chronic fatigue syndrome (ME / CFS)

Chronic fatigue syndrome, also known as myalgic encephalomyelitis / chronic fatigue syndrome (ME / CFS), is a disorder in which a person experiences severe fatigue that is often worse with physical or mental activity but does not improve with rest.

In addition to debilitating pain, many people with chronic fatigue syndrome report diffuse muscle and joint pain, as well as problems with concentration and memory, a sore throat, and / or dizziness or dizziness when standing up .

The ambiguous nature of fibromyalgia and ME / CFS symptoms is in part why these conditions are difficult to diagnose.

Polymyalgia rheumatica

Polymyalgia rheumatica (PMR) is an inflammatory disorder that occurs in older people, usually between the ages of 60 and 70 and almost never before the age of 50. This condition causes morning pain and stiffness in the shoulders, shoulders, hips, thighs , etc. and on the nape.

People with PMR often complain of difficulty pulling up their socks or raising their arms over their shoulders to brush or wash their hair. Fatigue, weight loss, poor appetite, and fever can also occur .

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the joints, but it can also cause muscle pain. Muscle pain in RA, if present, is usually severe and felt throughout the body. In addition to muscle and joint pain, there may be a low fever, weight loss, and fatigue .

Systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects almost every organ in the body. Muscle aches, pain, and / or weakness are very common with lupus and may actually be the reason a person seeks medical attention for the first time .

Inflammatory myopathy

Inflammatory myopathies are systemic autoimmune muscle diseases characterized by slow but progressive muscle weakness. Some people also experience muscle pain or muscle tenderness to touch.

The main types of inflammatory myopathies are:

Thyroid disease

Hypothyroidism (underactive thyroid gland) can cause muscle aches and pains in addition to other symptoms such as fatigue, weight gain, constipation, intolerance to cold, dry skin, and / or menstrual irregularities. Less commonly, an overactive thyroid gland ( hyperthyroidism ) can cause muscle cramps.

Primary adrenal insufficiency

Addison's disease , also known as primary adrenal insufficiency, is a rare (usually autoimmune) condition that occurs when the adrenal glands do not produce enough of the following hormones:

  • Mineralocorticoids, such as aldosterone, regulate blood volume and sodium / potassium balance.
  • Glucocorticoids like cortisol increase metabolism and help the body respond to stress.
  • Androgens , such as dehydroepiandrosterone (DHEA), which are eventually converted to sex hormones in the testes or ovaries.

This hormonal deficiency leads to a variety of symptoms, including muscle pain.

Osteomalacia

Osteomalacia means significant softening of the bones as a result of decreased bone mineralization due to vitamin D and calcium deficiencies.

In addition to muscle cramps and cramps, people with osteomalacia often report muscle weakness and bone pain and tenderness. Osteomalacia also increases the risk of fractures due to excessive weakening of the bones.

Depression

Depression, being a mental illness, is generally associated with physical symptoms such as muscle and joint pain. In fact, sometimes these general aches and pains are the only symptoms that a person reports to their healthcare provider.

Rhabdomyolysis

Rhabdomyolysis is a complex muscle disorder in which muscle tissue becomes so damaged that it begins to dissolve and release substances into the bloodstream.

The classic triad of rhabdomyolysis symptoms includes:

  • Muscle pain (frequent, severe): most pronounced in the hips, shoulders, lower back, and calves.
  • Muscular weakness
  • Dark urine due to the presence of myoglobin (a protein that stores oxygen in the muscles).

It is important to understand that rhabdomyolysis is a step up from other causes of muscle pain, as it is muscle pain associated with muscle breakdown.

Consequently, many causes of muscle pain (excessive exercise, statin use, or a viral infection such as the flu) can progress to rhabdomyolysis.

Other causes of rhabdomyolysis include :

  • Injury and compression (for example, from a car accident or prolonged immobilization)
  • Muscle hypoxia (eg, due to a blood clot)
  • Electrolyte imbalance (such as low potassium levels)
  • Changes in body temperature (such as heat stroke)
  • Alcohol abuse
  • Use of illicit drugs (such as cocaine or amphetamines)

When to contact a healthcare provider

If muscle pain worsens or persists, it is important to see a doctor as soon as possible for a correct diagnosis.

It is also important to seek immediate medical attention if you have muscle pain along with any of the following symptoms:

  • Difficulty breathing
  • Dizziness
  • Severe muscle weakness
  • Stiff neck muscles
  • Hot
  • Tick bite
  • Rash
  • Localized redness and swelling
  • Muscle pain after taking a new medicine.
  • Muscle pain that is very severe and / or comes on suddenly.
  • Swallowing problems
  • Weakness of the muscles of the head or neck.

Diagnostics

The diagnosis of muscle pain begins with a detailed history and physical examination.

History of the disease

When you meet with your healthcare provider, your healthcare provider will ask you a few questions to try to determine your diagnosis.

Questions can include:

  • Did the muscle pain appear gradually or suddenly?
  • Have you been in any vigorous activity lately?
  • What medications do you take?
  • Do you have any accompanying symptoms, such as fever, headache, weight gain or loss, or fatigue?
  • Are you experiencing muscle weakness too?
  • Is the affected muscle tender to the touch?
  • Is there redness, swelling, or warmth around the muscle?

Physical exam

During the physical exam, your doctor may press on various muscles to assess their sensitivity and examine the skin and surrounding tissues for inflammation, warmth, redness, or skin changes.

In particular, if your healthcare provider suspects myofascial pain syndrome, they will look for possible trigger points . Similarly, if fibromyalgia is suspected, your doctor will examine several tender points.

Blood test

Blood tests can be very helpful in diagnosing certain causes of muscle pain.

For example, an elevated inflammatory marker such as erythrocyte sedimentation rate (ESR) will be present in polymyalgia rheumatica.

Other appropriate (but not exhaustive) laboratory tests may include the following:

Display

During the diagnostic process, your healthcare provider may order one or more imaging tests. Examples of such tests include:

Other tests

Depending on the medical condition that your healthcare provider suspects, you may need to perform other tests to confirm the diagnosis. For example, to diagnose (and manage) compartment syndrome, your healthcare provider will insert a needle or thin tube into the affected muscle to access the pressure, performing what is known as a compartment pressure measurement .

A muscle biopsy can be done to diagnose inflammatory myopathy. Finally, if rhabdomyolysis is suspected, a urine myoglobin test will be ordered.

Watch out

After you are diagnosed with muscle pain, your healthcare provider will create a treatment plan that addresses both your pain and the underlying problem.

Self-service strategies

When muscle pain is associated with overuse, stretching, or bruising, it can be treated with the RICE protocol:

  • Rest: Allow injured muscles to rest as much as possible to allow acute inflammation to subside.
  • Ice: Apply a cold compress to the sore muscle for 15 minutes, about every four to six hours, and after exercising or using the muscles.
  • Compression: Wrap the sore muscle with an elastic bandage or bandage for support.
  • Lifting : lift the affected muscle above the level of the heart (if possible).

Medicines

In addition to relieving muscle pain, your healthcare provider may prescribe several medications to treat the underlying problem:

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs such as Aleve (naproxen) or Motrin (ibuprofen) are recommended for the treatment of certain muscle pain conditions, such as muscle strain / injury and myofascial pain syndrome.

Muscle relaxants

Muscle relaxants such as Flexeril (cyclobenzaprine) and Zanaflex (tizanidine) can be used to relieve pain from an acute muscle injury.

Antidepressants

Tricyclic antidepressants such as elavil (amitriptyline) are sometimes prescribed to treat myofascial pain syndrome, fibromyalgia, or chronic fatigue syndrome.

Similarly, other antidepressants, including the serotonin-norepinephrine reuptake inhibitor Cimbalta (duloxetine), may be used to treat myofascial pain syndrome or fibromyalgia, especially if the person cannot tolerate or receive any benefit from the tricyclic antidepressant. .

Corticosteroids

Corticosteroids (also called steroids) are used to treat many inflammatory conditions such as polymyalgia rheumatica and inflammatory myopathies.

Be aware that steroids (such as prednisone) have serious side effects when taken for a long time.

Steroid-sparing drugs

For inflammatory conditions, your healthcare provider may recommend that you take steroid-sparing medications (such as methotrexate for rheumatoid arthritis) early in your treatment to reduce prednisone use and help manage the disease in the long term.

Vitamin D

Treating osteomalacia requires addressing an underlying problem, for example addressing a vitamin D deficiency with prescription vitamin D supplements.

Antibiotic / antiviral / antifungal / antiparasitic

If you are diagnosed with pyomyositis, the infected muscle should be drained (if possible) and taken with antibiotics. Similarly, systemic myalgias caused by an infection require treatment for the underlying culprit, be it a bacteria, virus, fungus, or parasite.

Fluids and dialysis

Hydration and electrolyte replacement with intravenous fluids (through a vein) are vital for the treatment of rhabdomyolysis. In severe cases, if kidney function is impaired, temporary dialysis may be required.

Complementary and alternative treatments

Complementary and alternative therapies are commonly used to alleviate the symptoms of fibromyalgia and chronic fatigue syndrome.

Some of these treatments include:

Finally, another alternative therapy called a trigger point injection is sometimes used to treat myofascial pain syndrome.

Physiotherapy

Massage and a special type of therapy called a spray and stretch are commonly used to treat myofascial pain syndrome. Physical therapy may be recommended for people with fibromyalgia or chronic fatigue syndrome, especially a plan that is tailored to the individual's unique physical abilities.

Operation

Surgery is generally not required to treat muscle pain, except in some serious diagnoses. For example, pyomyositis requires surgical drainage of an abscess, and acute compartment syndrome requires fasciotomy, a procedure in which the skin and fascia covering the compartment are cut to relieve pressure.

Prophylaxis

While you can't prevent all types of muscle aches and pains, you can prevent some, especially sprains, cramps, and (for runners) chronic compartment syndrome :

  • Run on soft surfaces like grass or pathways instead of hard surfaces like concrete.
  • Wear soft shoe inserts.
  • Remember to warm up before exercising and cool down afterwards.
  • Switch to low-stress sports like swimming or cycling.
  • Stay hydrated (consider drinking electrolytes or taking electrolyte tablets that contain potassium, magnesium, and calcium ).

Get the word of drug information

Muscle pain is a difficult symptom, and based on your diagnosis, a comprehensive treatment plan may be required. Either way, the good news is that most types of muscle pain can be cured or well controlled. With that said, be sure to see your doctor if you experience muscle pain, especially if it is severe, persistent, or worsens.

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