Influence of Baseline Psychological Health on Muscle Pain During Atorvastatin Treatment

Abstract

Background HMG-CoA reductase inhibitors (statins) are generally well-tolerated, with statin-associated muscle symptoms (SAMS) the most common side effect (~10%) of statin users. However, studies and clinical observations indicate that many of the self-reported SAMS appear to be non-specific (i.e., not attributable to statins). Objective Mental health and wellbeing influences self-perception of pain, so we sought to assess the effect of baseline wellbeing and depression on the development of muscle pain with 6 mo of atorvastatin 80mg/d (ATORVA) or placebo in healthy, statin-naïve adults Methods The Psychological General Well-Being Index (PGWB; n=83) and Beck Depression Inventory (BDI; n=55) questionnaires were administered at baseline in participants (aged 59.5±1.2yr) from the STOMP trial (#NCT00609063). Muscle pain (Short-Form McGill Pain Questionnaire [SF-MPG]), pain that interferes with daily life (Brief Pain Inventory [BPI]), and pain severity (BPI) were then measured before, throughout, and after treatment. Results At baseline, there were no differences in wellbeing (PGWB), depression (BDI), or pain measures (SF-MPG and BPI) (ps≥0.05) between placebo and ATORVA groups. Baseline wellbeing correlated with baseline BPI pain severity (r=−0.290, p=0.008). Baseline depression correlated with baseline pain (SF-MPG; r=0.314, p=0.020). Baseline wellbeing and depression did not predict the change in pain severity or interference after 6 mo among the total sample or between groups (ps≥0.05). Conclusion Baseline wellbeing and depression were not significant predictors of pain after 6 mo of ATORVA (ps≥0.05). Thus, they do not appear to increase the risk of SAMS in otherwise healthy adults.

Clinical and psychological factors in coronary heart disease patients with statin associated muscle side-effects

“…Furthermore, we did not find any relationship between level of depression symptoms and report of SAMS. Our results are in line with a randomized trial reporting that higher depression scores within the normal range at baseline did not predict changes in muscle pain severity between atorvastatin and placebo group at 6 months follow-up in patients without cardiovascular disease and depression [ 3 ]. Others have found contrasting results with higher pain scores being associated with higher scores of depression in different patient populations [ 25 , 26 ].…”

“…Second, somatic symptoms, particularly muscle tension, are commonly found in persons with major depressive disorders and anxiety disorders, possibly explained by dysfunctions in serotonergic and noradrenergic systems [ 27 ]. These patients present higher distress scores of anxiety and depression than found in our study and the study by Zaleski et al where patients reported scores within normal range [ 3 ]. This may suggest that in order to identify such associations, distress and associated dysfunction in biological systems may be above a certain threshold.…”

“…Previous research has mainly focused on the pathophysiologic mechanisms underlying SAMS [ 1 ]. Even though associations between psychological distress and SAMS have been proposed [ 3 ], studies are scarce. Anxiety has been associated with increased pain perception [ 4 ], increased risk of misattributing muscle symptoms to statins or being hypervigilant to true adverse effects of statins such as muscle pain [ 5 ], and thus may render a patient more susceptible to SAMS.…”

“…Anxiety has been associated with increased pain perception [ 4 ], increased risk of misattributing muscle symptoms to statins or being hypervigilant to true adverse effects of statins such as muscle pain [ 5 ], and thus may render a patient more susceptible to SAMS. On the contrary, a randomized controlled atorvastatin trial in patients without cardiovascular disease, did not find distress in terms of higher levels of depression to predict changes in muscle pain severity between the atorvastatin and placebo group after 6 months follow-up [ 3 ]. Other psychological factors with potential associations to increased pain perception, musculoskeletal pain and more widespread pain syndromes are distressed (i.e.…”

Literature Review of Atherosclerosis Treatment with Hibiscus Sabdariffa as an Alternative for Statin Therapy

“…HS or often called rosella is recognized as a plant, easily grows in tropical and subtropical areas. HS plants have traditionally been involved in food ingredients, flavoring or taste enhancers in the food industry, spices and herbal medicines [14]. In general, the red color of HS petals is due to the compounds delphinidinsambubioside (red pigment) and cyanidin-sambubioside (pink pigment) as an alternative to synthetic dyes.…”