Muscle Pain with Statin and Nocebo Effect

A series of randomized, placebo-controlled n-of-1 trials (a randomized trial in individual patients) found no overall effect of atorvastatin 20 mg on muscle symptoms compared with placebo in participants who had previously reported severe muscle symptoms when taking statins. A total of 200 participants who had recently stopped or were considering stopping treatment with statins because of muscle symptoms were randomized to a sequence of 6 double blinded treatment periods (two months each) of atorvastatin 20 mg daily or placebo. 151 participants provided symptoms scores for at least one statin period and one placebo period and were included in the primary analysis. Overall, no difference in muscle symptom scores was found between the statin and placebo periods. Withdrawals because of intolerable muscle symptoms were 18 participants (9%) during a statin period and 13 (7%) during a placebo period. Two thirds of those completing the trial reported restarting long-term treatment with statins. The findings are in line with previous and concurrent studies and suggest a nocebo effect since most patients taking statins did not experience symptoms causally related to their statin. However, a causal link between statins and rare risk of myopathy, even severe rhabdomyolysis is well characterized. Source: https://www.bmj.com/