Since persistent or chronic pain is one of the most common complaints from taking statin drugs (even after stopping the drug), I felt this article by Dr Duane Graveline should have its own page. I will continue to add additional articles on pain management, so check back occasionally.
In many seriously damaged statin victims, pain control is of paramount importance. I am referring here to statin associated cases of chronic peripheral neuropathy, chronic myopathy and the chronic neuromuscular degenerative conditions commonly referred to as ALS-like or those resembling Parkinsonism and many others.
If pain is of primary concern it must be treated aggressively by those competently trained in pain management. In my own case pain has been my first and foremost complaint. Only recently has weakness and incoordination entered the picture.
Years ago my working diagnosis was spinal stenosis. Then came my brief exposure to Lipitor® followed by increasing awareness of back and leg pain. Two courses of spinal decompression and titanium rod stabilization followed.
My occasional intake of naproxen, an over the counter, anti-inflammatory medicine, gradually required the addition of codeine, then tramadol, then hydrocodone and oxycodone. I saw a rheumatologist, then a neurologist. Only the neurologist accepted the possibility of statin effect.
Finally I met a real pain management specialist at a social where I was talking on the subject of the little known side effects of statin drugs. I do not mind telling you that my talks had become a constant challenge of taking sufficient medicine to get me to the podium without having the medication affect my recall.
When this doctor offered that pain management was an important part of medical management, I listened. My new doctor's credentials reflected perfect training for this pain management role. From the very first moment I knew I was in good hands. From the time I started the treatment plan of this new doctor I have been almost completely pain free.
It might surprise you to know that after 23 years of family medicine I was a newcomer to pain management. Yes, I had treated my occasional severe back ache and headache patients in abundance but I cannot recall ever treating a patient whose only complaint was chronic pain.
One of the first things my new doctor did was add OxyContin®. "This drug will make a world of difference because it is long acting", I was told. Additionally I was given lidocaine patches, a remarkable treatment for those where there is at least some localization of the pain. This was new to me and I could see how it would have helped me manage gout attacks and severe muscle injury when I was in practice.
Ultram 300mg was added and my oxycodone was reduced to "as necessary only". Additionally all recreational walking was prohibited and I was enrolled into a water aerobics class to maintain my physical condition without straining my muscles.
The result of all this has been miraculous to me but I suppose it was just routine by the standards of a pain specialist. I have not had any significant pain since I started this new treatment plan. My mind is now clear and I feel twenty years younger. I stopped the lidocaine patches after the first two weeks and my intake of oxycodone is now rare.
The three groups mentioned above in my opening paragraph all are associated with pain to varying degrees - the pain of neuropathy, myopathy and the pain of neuromuscular degeneration (which has been my personal cross to bear).
In today's pro-statin climate, if a statin victim with peripheral neuropathy sees a neurologist the treatment plan frequently will consist of tricyclics (used exclusively as anti-depressants when I was in practice), followed by Neurontin®, then Tegretol® and the NSAIDS ( nonsteroidal anti-inflammatory drugs).
Narcotics will frequently be the last drug chosen since the neurologist refuses even to consider the possibility of statin inhibition of CoQ10 leading to mitochondrial DNA mutation as the mechanism of action.
My instinct tells me if attention is focused on pain, as in my case, the results in many cases will be rewarding. The patient is not healing damaged mitochondria with pain medication but is comfortable and much more functional as other treatment avenues are being explored.
The situation is not much different for the statin myopathy patient who seeks help from a specialist. Many specialists still have difficulty accepting statins as a cause of chronic myopathy even though myopathy is now generally agreed to have an incidence of at least 10%.
This is a far cry from the less than 2% incidence figure claimed earlier by the drug companies or incidence figures of 25% or more consistently observed in specific population groups such as athletes when exposed to statins.
Of even greater importance to statin users is that 68% of all those experiencing myopathy will find their condition is permanent and progressive even though the statin was promptly terminated. Knowing this could be a lifetime requirement, doctors are understandably reluctant to get involved in pain management, especially when the underlying mechanisms of statin adverse reactions still are incompletely understood.
Most of these statin victims will benefit greatly by referral to a pain management specialist. Many doctors, especially those in primary care will consider themselves entirely competent to manage pain but this is simply not so. My 23 years in general practice taught me very little relevant to what I have just learned about pain management from my new doctor and I have had only the briefest of introductions.
Meanwhile multi-disciplined research teams are working out the details of mitochondrial repair and maintenance. Some of this new research centers on the benefit of exercise which stimulates mitochondrial genesis.
This can be very misleading. I can say from experience that regular exercise such as walking is counterproductive in these cases of statin associated muscle damage. The exercise merely throws additional work on the remaining intact muscle fibers causing excess strain and increased pain. This is why only the very special non weight-bearing exercise of water aerobics has much to offer here. No pain management program, in my opinion, is complete without it.
Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor