Yay! Statins! Muscles! We all know that the issue of statins causing muscle pain is 99% bullshit, and results from suggestible patients who didn’t really want treatment in the first place misattributing muscular aches they were already getting/would have got anyway. With the exception, maybe, of the one patient I’ve seen whose statin-induced myalgia was possibly genuine given that it must be hard to think yourself into a CK of 17,000. Yeah, but that aside, it’s all cobblers, isn’t it, and patients are stopping these drugs at the first sign of an irrelevant twinge.
And now there’s evidence to back this up. To summarise, patients on statins only really complained of muscle aches when they were made aware that they were taking the drugs (rather than placebo) and therefore had an expectation that they might develop a problem.
This suggestibility reaches its peak of absurdity for me when I try to prescribe amitriptyline – which I do, frequently, on account of it curing everything. I trot out the side effect list of ‘constipation, dry mouth and dizziness’, at which point I one-hundred-per-cent guarantee the patient will say, using these exact words, ‘I get those already’. I’ve mentioned this before, I know, but it’s so fascinating, consistent and hilarious and I’m going to keep banging on about it until someone gives the observation the credit it deserves, specifically by officially labelling it ‘Copperfield syndrome’: the experience of drug side effects in advance of the drug actually being prescribed.
Anyway, the message is clear. Some patients you just know will get side effects from their statins, or whatever, because they get side effects from everything, so don’t even bother.
And for the rest, don’t tweak their side effect antennae with well-meaning risk/benefit discussions. Dish out the meds, tell them nothing and instruct them to burn the patient information leaflet. What could go wrong? Apart from rhabdomyolysis, obviously.