Body Aches

This topic deals with generalized muscles aches all over, not just one arm, or lower leg, etc. “Myalgias” is the medical term (“myo-” = muscle; “-algia” = pain).  See Body Aches — Full Text for more in-depth explanations and discussions.

First step — be sure we’re talking about muscles, not joints.  Muscles are our meat; joints are spaces where bone meets bone.  Some patients say they have pain all their “bones.”  But bones can only hurt in specific places; if all the bones hurt, it’s really the muscles.

Causes of Muscle Pains (Myalgias)

Diagnosis of Recent Onset Muscle Aches (Myalgias)

1.  First week of symptoms, we assume it’s a simple Viral Illness.  BUT must rule out serious illness (which are quite rare):

• First rule out Covid-19. Every office, clinic, etc. has its own way of doing this, before they let a patient inside.
• If Fever present, it could surely be Covid, but other diseases too. See link to that topic for how we rule out serious illnesses.
• Worry about possible Sepsis in patients with weak immune systems
• If patient reports urine is reddish-brown, we obtain a specimen, and perform urine dipstick test for blood.  If positive, we send to ER (possible Rhabdomyolysis; very rare)
• If muscles are very tender to touch, test urine as above to rule out Rhabdomyolysis

2.  If none of above, and symptoms continue more than a week, we:

• Obtain blood tests:
  • Complete Blood Count (CBC), for suggestion of infections or other illnesses
  • Comprehensive Metabolic Panel for abnormal calcium, potassium, etc.
  • Muscle enzyme CK (CPK) (for muscle destruction)
  • maybe Magnesium level
• Discontinue Statin Medication, or other medication that can cause myalgias (we’d look up side effects of all patient’s meds, & think about those prescribed recently)

3.  If all blood tests are normal, and symptoms persist unchanged another 1-2 weeks, we’d begin a work-up for chronic myalgias (see below)

Diagnosis of Chronic Muscle Aches (Myalgias)

1.  If patient taking a statin medication for high cholesterol, obtain blood test for muscle enzyme CK (CPK), and stop the medication.  If achiness goes away, and the CK wasn’t very high, try the statin again.  If symptoms return, the drug was probably the cause.

2.  Patients over 50 yrs. old  → rule out Polymyalgia Rheumatica (PMR):

• Stiffness of shoulders, neck, &/or hips for at least 30 min. in the morning.
• Obtain blood tests for ESR & CRP (indicating inflammation), and maybe for Anemia
• Diagnose PMR if (a) and (b) are positive.  Treat with steroids.  If not a lot better in a few days, diagnosis was wrong.
• If tests in (b) are normal, but diagnosis thought likely, get ultrasound of shoulder & hip for bursitis, tendonitis, or joint inflammation

3.  All patients with chronic myalgias, we order simple lab tests:

• Complete Blood Count
• General Comprehensive Metabolic Panel
• Thyroid test (TSH)
• Muscle enzyme CK (also called CPK)
• Maybe tests for chronic Hepatitis B & C
• Maybe an ANA to screen for rheumatologic conditions (only useful if very high)

4.  Rule out Depression (a common cause of muscle achiness)

5.  Rarely, may consider tests for widespread Bone Cancer (metastases / multiple myeloma) if:

• Elderly, and bones hurt (not muscles) when tapping or pounding on them
• Very high blood test Alkaline Phosphatase on general Comprehensive Metabolic Panel
• Known history of other cancer (especially breast, prostate, or lung)

6.  Consider Fibromyalgia if everything above negative, and all of the following apply (especially if age under 50):

• At least 3 months of pain or aches in many parts of the body  (and no fevers, drenching sweats, weight loss — if present, see those topics to guide work-up)
• significant problems feeling awake and refreshed, concentrating, and has significant fatigue
• various unrelated symptoms (headache, stomach discomfort, depression, & many more)
• See link for a formal Fibromyalgia Scoring System (mainly used in research)

See also Body Aches — Full Text for more in-depth explanations and discussions.