Chronic Muscle and Joint Pain
By Robin Bernhoft, MD, FACS
Chronic muscle and joint pain can arise from many different causes. Numerous drugs cause muscle pain as a side effect. These drugs include commonly-prescribed drugs like statins, cimetidine, penicillamine, nifedipine and various abuse drugs like heroin and cocaine. More commonly, fibromyalgia and polymyalgia rheumatica can also produce muscle pain.
A common feature to all these types of muscle pain is cellular inflammation. There is a cascade of inflammatory cytokines which produce pain. The nonsteroidal anti-inflammatory drugs (NSAIDs) (aspirin, Tylenol, ibuprofen, etc) attack this at the “bottom” of the inflammatory cascade. Unfortunately, the “bottom” of the cascade overlaps with several normal functions, which is why NSAIDs have side effects like ulcers and kidney problems, or in the case of the recently-recalled COX2 inhibitors, heart attacks. Corticosteroids have many similar side effects.
More recently, a class of anti-inflammatories called SKRMs (selective kinase response modulators) has been used to attack the cascade at the “top,” where it blocks the path leading to the specific pain problem; these have thus far seemed to avoid side effects. Clinical experience with SKRMs has been very encouraging.
Ultimately, though, the best approach to any symptom is to eliminate its cause, rather than minimize its effects. That being so, there are a number of approaches which often work in specific cases.
The first is based on the clinical observations of William Rea, MD, medical director of the Environmental Health Center – Dallas, that toxic environmental chemicals sometimes deposit in muscle. Dr Rea finds that environmental detoxification (avoidance of pollutants, organic diet, pure water, avoidance of chemicals, sauna, nutrient augmentation of liver excretory capacity, immune therapy) coupled with localized massage of the painful areas can relieve muscle pain.
Similarly, since “leaky gut” can allow absorption into the bloodstream of partially-digested food particles and various other inappropriate materials which can irritate muscle, joint cartilage and other structures (often because of shared immunological characteristics), attention to normalizing gut flora and function and minimizing consumption of foods which contain inflammatory chemicals (such as arachidonic acid) is often very helpful in reliving muscle pain symptoms.
Selected References:
- Plotnikoff GA, et al. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc. 2003; 78(12): 1463-70.
- Petersen AM et al. The anti-inflammatory effect of exercise. J Appl Physiol. 2005; 98(4):1154-62
- Inman RD. Antigens, the gastrointestinal tract, and arthritis. Rheum Dis Clin North Am. 1991; 17(2):3090-21.
- Mukherjee D, et al. Risk of cardiovascular events associated with selective COX-2 inhibitors. JAMA. 2001;286(8):954-9.
- Ray WA, et al. Cardiovascular toxicity of valdecoxib. N Engl J Med. 2004; 351(26):276.