EpistemisGeneralized myalgias
Specialty: General.
Why it occurs
- Systemic viral infections (dengue, chikungunya, influenza, Epstein-Barr virus or parbovirus B19, which induce direct or immune-mediated myocytotoxicity)
- Polymyalgia rheumatica (inflammatory disease of older people that causes severe pain and stiffness in the shoulder and pelvic girdles)
- Drug-induced myopathies (especially statins, fibrates, antiretrovirals or long-term glucocorticoids, due to cellular metabolic alteration)
- Fibromyalgia (central pain sensitization disorder that causes hypersensitivity to touch and generalized pain)
- Acute electrolyte and metabolic disorders (severe hypophosphatemia, severe vitamin D deficiency, hypothyroidism or cellular dehydration).
Initial workup
Total creatine phosphokinase (CPK), transaminases (AST/ALT), lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), 25-hydroxyvitamin D levels, serum electrolytes (calcium, phosphorus, magnesium), and urine myoglobin.
red flags
Presence of dark-colored urine (coluria/cola soda color), extreme elevation of muscle enzymes, rapidly progressive proximal muscle weakness, dysphagia, or dyspnea suggesting respiratory myositis or severe rhabdomyolysis.
Standard management
- Ibuprofen — 400 mg orally every 8 hours for a short period of 3 to 5 days, monitoring kidney function
- Cyclobenzaprine — 5 mg orally at night to reduce reflex spasm and excessive muscle tone
- Magnesium carbonate (250 to 500 mg per day orally to support the energy metabolism of muscle fibers).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- General
- Listed causes
- 5
- Treatment options
- 3