What are the treatment options for chronic myalgia (muscle pain)?

From the Guidelines

Chronic muscle pain can be effectively managed with acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line agents, due to their strong, high recommendation for the treatment of musculoskeletal pain. The most recent and highest quality study, 1, suggests that acetaminophen has fewer side effects than NSAIDs, and studies typically used 4 g/day dosing of acetaminophen, with lower dosing recommended for patients with liver disease.

Medication Options

• Acetaminophen (Tylenol) at 500-1000mg every 6 hours (not exceeding 3000mg daily)
• NSAIDs such as ibuprofen (Advil, Motrin) at 400-600mg every 6-8 hours with food
• For more severe pain, prescription medications like cyclobenzaprine (Flexeril) 5-10mg at bedtime, or duloxetine (Cymbalta) 30-60mg daily may be beneficial, as suggested by 1

Non-Pharmacological Interventions

• Physical therapy for 6-12 weeks, focusing on gentle stretching, strengthening exercises, and proper body mechanics
• Apply heat therapy for 15-20 minutes several times daily to increase blood flow and relax muscles, or cold therapy for acute flare-ups
• Regular low-impact exercise like swimming or walking for 30 minutes daily helps maintain muscle function and releases endorphins
• Ensure adequate sleep (7-9 hours nightly) and stress management through meditation or deep breathing exercises
• Cognitive behavioral therapy (CBT) is recommended for chronic pain management, as it promotes patient acceptance of responsibility for change and the development of adaptive behaviors, as suggested by 1

Considerations

• Clinicians should assess cardiovascular and gastrointestinal risk factors before prescribing NSAIDs and recommend the lowest effective doses for the shortest periods necessary, as suggested by 1
• If pain persists beyond 4-6 weeks despite these interventions, consult a healthcare provider for further evaluation and specialized treatment options.

From the FDA Drug Label

Cyclobenzaprine hydrochloride tablets are indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions Improvement is manifested by relief of muscle spasm and its associated signs and symptoms, namely, pain, tenderness, limitation of motion, and restriction in activities of daily living Cyclobenzaprine hydrochloride tablets should be used only for short periods (up to two or three weeks) because adequate evidence of effectiveness for more prolonged use is not available and because muscle spasm associated with acute, painful musculoskeletal conditions is generally of short duration and specific therapy for longer periods is seldom warranted

Chronic Muscle Pain Treatment:

• Cyclobenzaprine is indicated for the relief of muscle spasm associated with acute, painful musculoskeletal conditions.
• The medication should be used only for short periods (up to two or three weeks), as there is no evidence of effectiveness for more prolonged use.
• Cyclobenzaprine is not recommended for the treatment of spasticity associated with cerebral or spinal cord disease, or in children with cerebral palsy 2.
• Clinical Studies have shown that cyclobenzaprine is effective in relieving muscle spasm and its associated signs and symptoms, including pain, tenderness, limitation of motion, and restriction in activities of daily living 2.

From the Research

Treatment Options for Chronic Muscle Pain

• Nonpharmacologic treatment options are available for managing chronic muscle pain, including physical therapy, interventional techniques, and cognitive behavioral therapy 3.
• A multimodal treatment approach is recommended, as no individual therapy has consistent benefit for chronic musculoskeletal pain 4.
• Exercise, cognitive behavior therapy, and mindfulness techniques have been shown to be effective in improving pain and function in patients with chronic pain 4, 5.

Nonpharmacologic Interventions

• Exercise, particularly aerobic conditioning, muscle strengthening, flexibility training, and movement therapies, can improve pain and related symptoms in chronic pain conditions 6.
• Cognitive-behavioral therapy (CBT) has garnered good evidence of effectiveness as a stand-alone or adjunctive treatment for patients with chronic pain 5.
• Other nonpharmacologic interventions, such as spinal manipulation, acupuncture, massage, and low reactive level laser therapy, may also be beneficial for chronic muscle pain 4.

Considerations for Treatment

• Treatment should be tailored to the individual patient, taking into account their preferences, motivation, and physical limitations 4.
• A combination of pharmacological and non-pharmacological interventions may be the most effective approach for treating chronic widespread musculoskeletal pain 5.
• Physical activity should be prescribed individually, progressed slowly, and account for physical limitations, psychosocial needs, and available resources 6.