How do you treat patients with Muscle Pain (Myalgia)?

by branerpainclinic

Investigations And Types of Myalgia:Muscle Pain (Myalgia)

Muscle pain is a common medical complaint. There are many causes and clinical evaluation and appropriate investigation is often difficult. The physiological mechanisms producing such a symptom are limited.

  • Mechanical Pain: results from excessive muscle tension or contraction and is cramp like.
  • Inflammatory Pain: results from disruption of muscle fibres, inflammatory exudates and fibre swelling.
  • Ischaemic Pain: results from metabolic change, usually in response to exercise and is deep and aching.

Muscle pain may be physiological – as a consequence of extreme exercise or pathological – as a consequence of muscle, soft tissue or systemic illness.

DIAGNOSTIC APPROACH TO MUSCLE PAIN

History:

Is muscle pain

Present at rest

Present with exercise

  • Physiological
  • Metabolic myopathies
  • Benign myalgic encephalomyelitis  (ME)

Localized

Generalized

  • Polymyalgia rheumatica
  • Parkinson’s disease
  • Metabolic myopathies
  • Inflammatory myopathies
  • Benign myalgic encephalomyelitis (ME)

Family History

Exposure to toxins

  • Drug induced myopathies
  • Alcoholic myopathy

Examination:

Is There

Wasting/Weakness

Skin Rash

  • Inflammatory myopathy (dermatomyositis)
  • Collagen vascular disease

Stiffness or Spasms

  • Tetanus
  • Tetany
  • Spasticity
  • Neuroleptic malignant syndrome
  • Malignant hyperthermia

Muscle Swelling

  • Muscle abscess, tumors
  • Metabolic myopathy

INVESTIGATIONS OF MUSCLE PAIN

1 Serum Creatine Kinase (muscle enzyme)

2. Imaging (occasionally used)

  • Ultrasound, MR or CT in suspected muscle haematoma, abscess or tumors.
  • Radionuclide (Gallium or in suspected muscle abscess, Technetium)

3. Electromyography (EMG)

  • Will confirm presence of myopathy (rarely more specific)

4. Muscle Biopsy (needle or open)

  • Inflammatory myopathies metabolic myopathies
  • Helpful in collagen vascular disease

5. Ischaemic Lactate Test

  • Measurement of post exercise changes in serum lactate
  • Reduced response in-metabolic

Following extensive investigation, in a significant number of cases no cause of myalgia is found.

TYPES OF MUSCLE PAIN:

Most disorders are covered in relevant sections. Those that are not are briefly described.

1. Fibromyalgia

A common condition of uncertain pathology in which generalized muscle pain with localized tender areas occurs without objective clinical or laboratory abnormalities. Psychiatric symptoms commonly co-exist.

2. Malignant Hyperpyrexia

Characterized by a sudden rise in body temperature whilst undergoing general anesthesia usually with halothane or succinylcholine. Certain hereditary myopathic disorders e.g. myotonic dystrophy central core disease – are unduly prone to this condition.

3. Muscle Abscess

Commonly Staphylococcal due to local trauma or blood-borne in debilitated persons.

4. Polymyalgia Rheumatica

Proximal muscle pain encountered in the elderly and often associated with giant cell arteritis. The ESR is elevated and the EMG is normal. Muscle biopsy shows type 2 fibre losses. Steroids are effective.

5. Muscle Tumors

These are rare Mixed pathological and of varying degrees of malignancy.

6. Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME)

An idiopathic disorder that may follow viral illness is often associated with exercise induced muscle pain and associated with fatigue. No clear underlying pathology has been found and diagnosis is based on symptoms and exclusion of other pathology. May respond to graded exercise, tricyclic antidepressants or cognitive behavioral therapy.

Muscle pain is your body’s way of telling you about a problem. See your doctor if your myalgia is prolonged and persistent or if it is accompanied by other symptoms.Talk to your doctor about muscle relaxants to that may help ease your muscle pain.Call Us Immediately if you have: 1 (877) 573-1282.

If you get more detailed information about our Braner Pain Clinic Then Come Instantly our Website And Get Quick Appointment. http://www.branerpainclinic.com/

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