Uncovering 3 Medications That May Trigger MSK Symptoms
When managing musculoskeletal complaints, it is crucial to identify all factors that may contribute to symptoms or hinder the healing process. Most chiropractors focus on manual therapies and in-office interventions; however, the impact of medications on musculoskeletal health often goes underappreciated. In this blog, we will delve into three medications that may trigger MSK symptoms.
Understanding the potential effects allows patients and healthcare professionals to make informed decisions optimizing treatment outcomes, and promote recovery.
Accutane™ (Isotretinoin)
Anti-acne drugs are commonly used among adolescents and young adults, as this is the age group where severe acne is most prevalent.
Clinical signs include dryness of the skin and mucous membranes, muscle and joint pain.
Associated with isotretinoin therapy, individuals engaged in exertional exercise or contact sports report higher levels of muscle pain than anticipated, often accompanied by elevated creatine phosphokinase levels. (1)
Myalgia and arthralgias usually abate upon discontinued medication use and occur in 16 percent of patients using Isotretinoin. (2)
Antibiotics
Some antibiotics have been associated with potential effects on tendon or connective tissue healing. (3)
Fluoroquinolones interfere with collagen synthesis and degradation, which are essential processes in tendon repair. (3)
In multiple adult studies, fluoroquinolone use has been associated with an increased risk of tendon injury. (3-10) However, a more recent study demonstrated the excess risk of tendon rupture, tendinitis, and adverse events associated with fluoroquinolone treatment may be small when applied to a more extensive and diverse population. (11)
Statins
Muscle-related symptoms reported with statin use can range from mild muscle aches to muscle pain, weakness, or inflammation. (12)
“Rhabdomyolysis is a well-documented side effect of statin therapy.” (13)
Rhabdomyolysis is a rare but potentially severe condition characterized by the breakdown of muscle fibers, leading to the release of muscle proteins into the bloodstream.
These pain syndromes are often characterized as generalized due to the systemic nature of the drug.
There is no causal link between statins and muscle pain in the literature, but many patients note a reduction in symptoms once the drug is discontinued or the dosage is reduced. (12)
The benefits of statins may outweigh the potential risks to your patients. Using careful clinical judgment and coordination of care with the patient’s primary care provider may be necessary to manage potential side effects.
Chiropractic Care and Medication Use
Navigating conversations between chiropractors and medical physicians regarding medications can be a delicate matter, often requiring a thoughtful and diplomatic approach. It's essential to approach these discussions with openness and an explicit acknowledgment of your limitations and the medical physician's prescribing expertise. However, when approached respectfully, these conversations can foster referral relationships that benefit both parties. By fostering an environment of open communication and mutual respect, valuable collaborations can emerge, leading to improved patient care and well-rounded treatment options.
Want to learn more about PCP communication strategies that produce referrals? Check out this webinar with Dr. Brad Russel.
It is always essential to consult with a healthcare professional before making any changes to medication regimens, as individual circumstances may vary. Together, providers and patients can navigate the complex landscape of medication management and ensure the best possible outcomes for musculoskeletal health.
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Ellis CN, Krach KJ. Uses and complications of isotretinoin therapy. Journal of the American Academy of Dermatology. 2001 Nov 1;45(5):S150-7.
Orfanos, C.E. and Zouboulis, C.C. 1997. “Almond-Roesler B and Geilen CC. Current use and future potential role of retinoids in dermatology.” Drugs. 53:358–88.
Van der Linden PD, van de Lei J, Nab HW, Knol A, Stricker BH. Achilles tendinitis associated with fluoroquinolones. Br J Clin Pharmacol. 1999;48(3):433–437
Van der Linden PD, Sturkenboom MC, Herings RM, Leufkens HG, Stricker BH. Fluoroquinolones and risk of Achilles tendon disorders: case-control study. BMJ. 2002;324(7349):1306–1307
Corrao G, Zambon A, Bertù L, et al. Evidence of tendinitis provoked by fluoroquinolone treatment: a case-control study. Drug Saf. 2006;29(10):889–896
Sode J, Obel N, Hallas J, Lassen A. Use of fluroquinolone and risk of Achilles tendon rupture: a population-based cohort study. Eur J Clin Pharmacol. 2007;63(5):499–503
Hori K, Yamakawa K, Yoshida N, Ohnishi K, Kawakami J. Detection of fluoroquinolone-induced tendon disorders using a hospital database in Japan. Pharmacoepidemiol Drug Saf. 2012;21(8):886–889
Wise BL, Peloquin C, Choi H, Lane NE, Zhang Y. Impact of age, sex, obesity, and steroid use on quinolone-associated tendon disorders. Am J Med. 2012;125(12):1228.e23–1228.e28
Jupiter DC, Fang X, Ashmore Z, Shibuya N, Mehta HB. The relative risk of Achilles tendon injury in patients taking quinolones. Pharmacotherapy. 2018;38(9):878–887
Morales DR, Slattery J, Pacurariu A, Pinheiro L, McGettigan P, Kurz X. Relative and absolute risk of tendon rupture with fluoroquinolone and concomitant fluoroquinolone/corticosteroid therapy: population-based nested case-control study. Clin Drug Investig. 2019;39(2):205–213
Ross RK, Kinlaw AC, Herzog MM, Jonsson Funk M, Gerber JS. Fluoroquinolone antibiotics and tendon injury in adolescents. Pediatrics. 2021 Jun 1;147(6).
Pergolizzi Jr JV, Coluzzi F, Colucci RD, Olsson H, LeQuang JA, Al-Saadi J, Magnusson P. Statins and muscle pain. Expert Review of Clinical Pharmacology. 2020 Mar 3;13(3):299-310.
Ezad S, Cheema H, Collins N. Statin-induced rhabdomyolysis: a complication of a commonly overlooked drug interaction. Oxf Med Case Reports. 2018 Mar 14;2018(3):omx104.
