From the Guidelines
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most effective medicine for myalgia.
Key Points
- NSAIDs are more effective for pain relief than acetaminophen 1
- NSAIDs have anti-inflammatory and antipyretic properties, but their use is limited to patients not at risk for coronary artery disease 1
- Tricyclic antidepressants are an option for pain relief in patients with chronic low back pain and no contraindications to this class of medications 1
- Skeletal muscle relaxants are an option for short-term relief of acute low back pain, but all are associated with central nervous system adverse effects 1
- Opioid analgesics or tramadol are an option when used judiciously in patients with acute or chronic low back pain who have severe, disabling pain that is not controlled with acetaminophen and NSAIDs 1
Important Considerations
- Clinicians should assess cardiovascular and gastrointestinal risk factors before prescribing NSAIDs and recommend the lowest effective doses for the shortest periods necessary 1
- Potential benefits and harms of opioid analgesics should be carefully weighed before starting therapy, and failure to respond to a time-limited course of opioids should lead to reassessment and consideration of alternative therapies or referral for further evaluation 1
From the Research
Medications for Myalgia
- Pregabalin, gabapentin, or amitriptyline can be tried in conditions with myalgic pain 2
- Myotonia can be treated with mexiletine, while carbamazepine or phenytoin can be used in myotonic syndromes, particularly with muscle cramps 2
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequently documented pharmacologic intervention for paclitaxel-induced myalgias and arthralgias 3
- Gabapentin, glutamine, and antihistamines (e.g., fexofenadine) could be used to treat and/or prevent myalgias and arthralgias 3
- Tricyclic antidepressants, cyclobenzaprine, and serotonin-norepinephrine reuptake inhibitors have strong evidence of benefit in fibromyalgia management 4
Non-Pharmacologic Therapies for Myalgia
- Personal low-frequency stimulation (PLS) device can offer positive assistance in pain alleviation for patients with myalgia, with effects comparable to conventional physical therapy (PT) treatment 5
- Local cold therapy can reduce myalgia pain levels, especially quickly, with significant differences in pain levels after 10 minutes of treatment 6
Treatment Approaches for Myalgia
- Treatment should aim to improve or correct the underlying cause for myalgia, such as inflammation or hypothyroidism 2
- A patient-centered, multimodal approach that includes patient education, behavioral therapy, a graded exercise program, and pharmacotherapy should be used for patients with fibromyalgia 4