51动漫

I don鈥檛 really want to be the poster boy for statin-induced muscle aches, but here goes. I have written for 51动漫 about my experience with statins, and how I believe atorvastatin turned me into a couch potato because I could no longer do significant exercise without debilitating pain.

Now that I鈥檓 off statins, which lower cholesterol, I can sprint, lift weights and build muscle again. It鈥檚 great. But could the pain have been in my mind?

That鈥檚 the story doing the rounds this week. A in The Lancet concludes that it is the expectation that statins cause muscle aches that leads to people experiencing muscle aches. This is called the 鈥�nocebo effect鈥�. The idea is that your anticipation of harm results in biochemical changes that can cause ill effects, such as pain.

It鈥檚 not a new idea. In my earlier article I referred to experiments suggesting that this is indeed a problem. However, this week鈥檚 story isn鈥檛 the last word, whatever the headlines say.

That鈥檚 partly because some of the data it draws on is 15 years old, from a time when statins and their side effects weren鈥檛 a major part of the news cycle and so they may not have been as commonly anticipated.

Widespread reporting

to this research, Liam Smith of the London School of Hygiene and Tropical Medicine says that 鈥渢he widespread reporting that statins commonly cause muscle symptoms appears to have led to an increase in muscle symptoms鈥�. Was there widespread reporting about this more than a decade ago?

What鈥檚 more, the study (partly sponsored by Pfizer) looked at only one statin: atorvastatin (first marketed by Pfizer). Different people have a different reaction to different statins, and so the results of one study on one statin cannot be generalised.

I should also mention that the subjects in this study were on a very low dose: 10 milligrams. My doctor told me, when I complained of muscle aches, that I was only on a 鈥渂aby dose鈥� of 20 milligrams daily. I should, he said, be on a significantly higher dose.

Then there鈥檚 the actual numbers. The study looked at roughly 10,000 people split into two groups. In the first phase, spanning 1998 to 2002, nobody knew whether they were taking a statin or a placebo. In this phase, 298 out of 5101 statin-takers聽(5.8 per cent)聽reported muscle pain, with a similar figure in the placebo group.

In a second phase, researchers chose to compare those who knew they were taking statins with those from the original phase who actively chose not to continue with statins. This is what researchers call non-blinded, as everybody knows who is getting what. So one group getting statins was compared with another not given any pills, placebo or otherwise. Here, reports of muscle aches are higher among knowing statin-takers than those not taking them.

Nocebo effect

According to the researchers, that proves a nocebo effect. Does it? I鈥檓 not convinced. The comparison is between two entirely different protocols.

To test for nocebo, a more straightforward comparison might be between the percentage of people reporting muscle aches when they knew they were on statins, and when they didn鈥檛. In this analysis of the study鈥檚 data, reports dropped by more than half when subjects knew they were taking a statin. In other words, there鈥檚 no nocebo effect when you cut the data this way.

So I think I will wait for the results of trials specifically designed to answer this question that are still ongoing, such as . When I asked experts about data on muscle aches while researching my earlier article, I was repeatedly told that the studies done so far were more concerned with efficacy in lowering cholesterol and reducing the frequency of heart attacks and strokes.

Any data on muscle aches would be largely unreliable, I was told. So if you are experiencing muscle problems that you think are due to statins, it鈥檚 too soon to diagnose you 鈥� and me 鈥� as delusional.