14 Medications That Could Be Causing Your Pain

Common Medications that cause joint and muscle pain

 Joint pain affects most people, and even though arthritis is a common cause, the main culprit could be medication. Even medications that are meant to alleviate pain, can actually be causing pain (NSAIDs and Opioids see below). So before you blame arthritis for your joint or muscle pain, check out these fourteen medications. And if your medication is on this list make sure you do not stop the medication or adjust its dose without discussing with your health care practitioner.

1.      Antibiotics, e.g. Levoflaxin

Levofloxacin is a type of antibiotic from a group of antibiotics called fluoroquinolones, often used to treat pneumonia and sinus infections. Research indicates that 14% of people who use fluoroquinolone antibiotics reported joint and muscle aches. The study further reveals that levofloxacin was more likely to cause joint and muscle pain than other antibiotics in the same class. Furthermore, adults over 60 have a higher risk of this side effect than younger adults [5]. 

People who experienced the pain reported that the pain often starts usually around three days after starting the antibiotic. Other studies reveal that the pain typically disappears within seven days after stopping the medication [5].  A side effect of fluroquinolones can be tendon rupture so it is very important to report any type of muscle or joint pain to your healthcare provider if you are taking this class of antibiotics.

2. Statins: Medications used to lower cholesterol

Statins are a group of drugs used to lower cholesterol levels by blocking the liver from producing cholesterol. Although statins effectively reduce cholesterol, one of their potential side effects is muscle pain. The prevalence of muscle pain is not directly related to the dosage of statin, but often reducing the dosage reduces the pain induced by the drugs.

A study reveals that 0.03%  of people taking 20mg of simvastatin (a type of satin) experienced muscle pain, while 0.9% of those taking 80mg had muscle pain. In a different study, about 9% of people taking another type of statin called atorvastatin experienced muscle pain, 5% more than those taking a placebo [5].

3. Biphosphonates

These are drugs used to treat osteoporosis which is a condition that causes weak and brittle bones. Their mechanism of action is to prevent minerals from dissolving and leaking from the bones to the bloodstream.. However, one of their side effects is mild joint pain. For example, one drug called Fosamax (alendronate) has a warning on its label that states that severe bone, muscle, or joint pain may occur after using the drug [5].

4. Asthma Inhalers

Inhalers containing corticosteroids are commonly used to treat asthma and other lung conditions by reducing inflammation (swelling) in the lungs and helping to open the airways. The inhaled steroids can cause a rare, severe bone condition called osteonecrosis in a small number of people after long term use. The condition occurs when the bones don’t get sufficient oxygen and start to die. Oral or injected steroids are more likely to cause severe bone side effects than inhaled steroids, whose cases are rare. However, inhaled steroids are likely to cause muscle pain, although the cases are rare. For example, Flovent (fluticasone) includes muscle pain as a possible side effect on its label [5].  Make sure you report any type of joint or muscle pain to your healthcare provider when taking any corticosteroids.

5. Breast cancer medication

Drugs such as anastrozole, letrozole, and exemestane (aromatase inhibitors), are used to treat breast cancer by blocking the production of estrogen hormone in the body. Patients take the medication on a long term bases to prevent reoccurrence of cancer after the initial treatment. Some studies reveal that 47% of people taking the medication experience joint pain [5].

6. Isotretinoin: Acne treatment

Isotretinoin (Absorica)  is used to treat severe acne. Studies reveal that about 16-51% of people taking this medication may experience muscle pain or stiffness. A different study shows that more people reported pain as a side effect of using the medicine. According to the study, 70% of the people using Isotretinoin had back pain, while 53% of them had muscle pain, and 48% had joint pain.

7. Anti seizure medication: Pregabalin

Pregabalin (Lyrica) is used to treat different types of nerve pain caused by fibromyalgia and diabetes and also seizures for epileptic patients. Some patients may experience joint pain after using this medication. If you experience joint pain when using the drug, speak to your doctor because they may give you alternative medicine, such as gabapentin (Neurontin) which does not cause joint pain.

Pregabalin versus gabapentin

Both pregabalin and gabapentin are used to treat nerve pain and epileptic seizures. They are also approved for anxiety disorders (in Europe) but are not the same and have significant differences even though they treat similar conditions [6]. Both drugs are used for conditions such as fibromyalgia, neuralgia, and neuropathic pain due to diabetes or spinal cord injury. They have a similar chemical structure, and their similarity is that they block certain brain signals that are responsible for pain perception [7]. They don’t address the reason the pain started but instead these drugs block your ability to feel the pain.  Keep in mind the underlying reason still needs to be addressed.

Lyrica is a brand name for Pregabalin, while Gabapentin is a generic name for all types of gabapentin, such as Horizant and Neurontin. They both belong to a class of drugs called gabapentinoids. Although they treat similar conditions, you cannot use them interchangeably without your doctor’s advice [6]. Both drugs may be addictive and are associated with misuse in some countries and are controlled drugs that can be taken only under prescription.

One of the main differences between the two is,  Lyrica is absorbed more quickly by the body and works faster (within an hour of taking it) and gabapentin takes 3-4 hours to reach its peak concentration. Lyrica is more likely to cause side effects such as weight gain, constipation, or dry mouth. In contrast, gabapentin can cause an increased risk of viral infections, jerky movements, fever, and difficulty speaking [6] and ironically with long term use, it can contribute to pain.

8. Premarin: estrogen medication

Premarin is a hormonal drug that contains conjugated estrogen and is used to manage menopausal symptoms such as hot flashes during menopause or for women with low estrogen levels. About 6% of people using the drug may experience joint pain [5].

9. Caervedilol: Blood pressure medication

Some medications used to manage high blood pressure may cause pain in some people. Carvedilol, also known as a beta blocker, relaxes the muscles of the class in the blood vessels and the heart to lower blood pressure. It is used to treat patients with high blood pressure or heart failure. About 6% of people using the medication experience joint aches and back pain [5].  Lisinopril has also been associated with joint or muscle pain in some people.

10. Anti-inflammatory drugs: NSAIDs

Anti-inflammatory drugs such as ibuprofen (nonsteroidal anti-inflammatory drugs NSAIDs) and steroids are used to relieve short term pain. Although NSAIDs resolve short-term pain, they can also cause chronic pain in some people.  They can produce other side effects, such as kidney problems, and irritate the gastrointestinal tract [9]. Studies show that the use of anti-inflammatory drugs caused an increased risk of persistent long term pain compared to when patients used other pain relieving medications (analgesics) [10]

Inflammation is a natural body response to injury or infection. The body uses the natural pathway to modulate the pain and promote healing. Anti-inflammatory medication blocks the natural pathway and can alter the body’s response and perception of pain as well as healing.. By blocking inflammation, the drugs may disrupt healing. 

But how does the antiinflammatory medication alter the perception of pain?

There is a particular cell in the body called neutrophils which is a key player in the pain response by the body. Anti-inflammatory drugs block neutrophils to stop pain signals from reaching the brain and helps to reduce acute pain [9]. The drugs inhibit the natural healing process and thus lead to prolonging the duration of the pain and increasing the risk of developing chronic back pain [10]. Therefore, blocking the neutrophils increases the chances of pain in the long term tenfold. The study of about 500,000 people reveals that people who regularly took anti-inflammatory medication experienced chronic pain for two to ten years [9].

There is a need to reexamine the use of anti-inflammatory medication in the short term and how it translates to the development of chronic pain. 

11. Opioids

Historically, opioids are drugs such as morphine, oxycontin and oxycodone  used to relieve pain for patients with advanced cancer, bone fractures, or after surgery or a serious accident, but are meant for short duration. However, there has been a drastic increase in the use of opioids for chronic pain due to back pain or arthritis, which may be medically unnecessary and cause serious side effects [11]. 

Opioids activate receptors to block pain signals from reaching the brain. However, when used for a long time, the body reacts as a defense mechanism to overcome the blocking of the pain signals by activating other pain signals and pathways, leading to hypersensitization, meaning you perceive more pain even with a minor injury [11].

Although opioids are supposed to numb the pain, they may cause some patients taking opioids to be more sensitive to pain than those who are not taking opioids. 

But how do opioids change your perception of pain? 

Your body has a natural response to injury. Once the pain signals reach the brain, it triggers a natural body response to repair the damaged tissues and promote healing. When you take opioids to block pain, it can disrupt the homeostasis or natural body response. Then the brain senses the change and tries to restore homeostasis and in the long term it can recruit other pathways to do the job. This leads to more pain. 

According to research, using opioids significantly increased sensitivity to pain and worsened preexisting pain, and taking higher doses caused higher sensitivity to pain. When used for a long time, your body adapts to the doses, leading to tolerance, and you may need higher doses to achieve the same effect [12].  Therefore, increasing the dosage to deal with the pain increases pain sensitivity and may lead to overdependence on the drug and lead to a vicious cycle of higher doses and more pain.

The reaction to opioids is varied depending on the individual. Some people may get far worse effects than others, and it is unclear how much exposure to opioids can lead to hypersensitization. However, people who regularly take opioids are at risk of developing opioid-induced hyperalgesia. Hyperalgesia refers to increased sensitization to pain, meaning that your body perceives more pain when exposed to a stressor/stimuli than usual [13]. 

For example, when you go for lab testing, and they draw blood from your veins, it causes mild discomfort, but some patients taking opioids may experience excruciating pain.  The high response to pain is what is called opioid-induced hyperalgesia.

So is pain less harmful than opioids? 

It is paradoxical that medication that should relieve pain actually increases it. Long-term use of opioids leads to more pain than they relieve and can cause opioid-induced hyperalgesia. Abstinence from opioids should resolve the hyperalgesia depending on the individual and how long you took the medication [12]. The right approach is to slowly wean from higher doses over time and switch to non opioid alternatives such as Softwave therapy, gut repair,  exercise, and behavioral interventions [11]. 

12. Antidepressants

Antidepressant medications, specifically selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), can trigger muscle stiffness, joint pain, and fibromyalgia-like symptoms in certain individuals.

13. Corticosteroids

Corticosteroids, such as prednisone, are powerful anti-inflammatory medications. However, their long-term use can cause muscle weakness, joint pain, and a condition known as avascular necrosis, where bone tissue dies due to reduced blood supply.

14. Cortisone Injections

New research shows that cortisone injections can actually lead to the degeneration of joint surfaces which over the longer term can result in pain. [14]

Never stop taking any of these drugs without consulting your doctor.

References

  1.  https://www.solent.nhs.uk/media/1755/explain-pain-booklet-final-version-comms-edited.pdf
  2. https://www.nih.gov/news-events/news-releases/nih-study-finds-high-rates-persistent-chronic-pain-among-us-adults
  3.      https://abcnews.go.com/Health/PainManagement/story?id=741257&page=1#:~:text=But%20enduring%20pain%20or%20stress,Clinic’s%20Chronic%20Pain%20Rehabilitation%20Program.
  4.  https://www.frontiersin.org/articles/10.3389/fimmu.2019.01699/full
  5.      https://www.goodrx.com/drugs/side-effects/common-medications-that-cause-joint-pain-cholesterol-drugs-asthma-inhalers
  6.  https://www.drugs.com/medical-answers/difference-between-lyrica-gabapentin-3508860/
  7.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2895293/#:~:text=Gabapentin%20(GP)%20and%20pregabalin%20(,containing%20the%20a2d%2D1%20subunit.
  8.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6439871/
  9.  https://www.healthline.com/health-news/anti-inflammatory-drugs-may-lead-to-chronic-pain
  10.  https://www.science.org/doi/10.1126/scitranslmed.abj9954
  11.  https://www.health.harvard.edu/blog/more-opioids-more-pain-fueling-the-fire-2019070817024
  12. https://www.hss.edu/conditions_opioid-induced-hyperalgesia.asp
  13.  https://pubmed.ncbi.nlm.nih.gov/21412369/
  14. https://www.healthline.com/health-news/steroid-injections-in-the-knee-and-hip-can-cause-more-damage#Arthritis-acceleration

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