Side Effect: Muscle pain (myalgia)

What is Muscle pain (myalgia)?

Muscle pain, also known as myalgia, is discomfort or pain in the muscles. Muscle pain can be caused by a variety of factors, including physical activity, injury, infection, or chronic diseases such as cancer.

What does Muscle pain (myalgia) look like?

• Muscle pain can not usually be seen, but severe muscle damage can sometimes be detected by using a blood test known as the “CPK” which stands for Creatine PhosphoKinase.
• Muscle pain is typically characterized by discomfort, soreness, or aching sensations in the affected muscle or muscles. It can range from mild to severe and can affect any muscle in the body.

Who gets Muscle pain (myalgia)?

Patients with cancer can experience muscle pain due to the disease itself, as well as the side effects of cancer treatments such as chemotherapy, radiation therapy, and hormonal therapy. In addition, cancer-related fatigue, infection, increased muscle usage, poor sleep, and depression can contribute to muscle pain as well.

Cancer therapies that have been reported to cause muscle pain include, but are not limited to:

• Chemotherapy:
  • docetaxel (Taxotere®), paclitaxel (Taxol®)
• Aromatase inhibitors:
  • anastrozole (Arimidex®), exemestane (Aromasin®), letrozole (Femara®)
• Estrogen receptor blockers:
  • fulvestrant (Faslodex®), tamoxifen (Nolvadex®)
• Growth colony stimulating factors (GCSF):
  • filgrastim (Neupogen®, Granix®, Zarxio®), pegfilgrastim (Fulphila®, Neulasta®, Udenyca®), sargramostim (Leukine®)
• Cytokine therapies:
  • interferon (Intron A®, Pegasys®), aldesleukin (Proleukin®)

How to prevent Muscle pain (myalgia)

Preventing muscle pain in patients with cancer can be challenging, but there are some strategies that can help:

• Exercise
  • This may seem counterintuitive because over-exercising can lead to muscle soreness but mild to moderate physical activity every day helps keep muscles loose and functioning well
• Eating a balanced diet
• Good sleep habits
• Adjusting dosage or stopping medications causing muscle pain

How to treat Muscle pain (myalgia)

Treating muscle pain in patients with cancer requires a personalized approach that considers the underlying cause of the pain, the severity of the pain, and the patient's overall health status.

Treatment options for muscle pain may include non-medication approaches such as:

• Physical therapy
• Massage
• Hot or cold compresses
• Transcutaneous electrical nerve stimulation therapy (TENS)
• Acupuncture

In addition to non-drug therapies, certain over-the-counter as well as prescription medications may be tried after non-drug treatments are tried and are not completely effective.. Some medications that may be used include:

Over-the-counter pain relief:

• Acetaminophen (Tylenol®)

• Over-the-counter Non-Steroidal Anti-Inflammatory Drugs (NSAIDs):
  • ibuprofen (Advil®, Motril®)

Prescription only:

• Prescription Non-Steroidal Anti-Inflammatory Drugs (NSAIDs):
  • naproxen (Aleve®)
  • meloxicam (Mobic®)
  • celecoxib (Celebrex®)
  • ketorolac (Toradol®)
• Muscle relaxants:
  • cyclobenzaprine (Flexeril®)
  • methocarbamol (Robaxin®)
  • tizanidine (Zanaflex®)
  • baclofen
• Antidepressants:
  • duloxetine (Cymbalta®)
  • venlafaxine (Effexor®)
  • amitriptyline (Elavil®)
• Anticonvulsants:
  • gabapentin (Neurontin®)
  • pregabalin (Lyrica®)
• Opioids:
  • hydrocodone (Norco®
  • Vicodin®)
  • oxycodone (Percocet®
  • Roxicodone®)
  • tramadol (Ultram®)
  • NOTE: Opioids are typically reserved for short to medium term therapy for muscle pain that has not responded to other medications and non-pharmacologic approaches.