Muscle Pain soon after start of meds
Jul 13, 2004
Within 1 week of starting Combivir & Sustiva therapy (previously treatment-naive), I developed a dull, throbbing pain under my right shoulderblade, which after several more days radiated a bit into my upper right arm. By the end of the second week, nighttime pain was almost unbearable (7 or 8 out of 10). Consulted with my physician and an urgent-care physician. Chest X-ray negative, but was told that a soft-tissue problem would be harder to diagnose specifically (possible bursitis). Muscle relaxants (Soma, Skelaxin) did not provide any relief.
Pain subsided only slightly after stopping all therapy for 2 days (between regimens), but is now back, keeping me awake a good part of the night, and is now more localized in upper arm & forearm. Pain seems worst about 4-5 hours after taking drugs.
I am working with my physician on this, but I have found only limited written information on myositis/myalgia having acute onset after the start of drug therapy. How common are musculoskelatal/ neurologic problems on one side only, and soon after start of drug therapy? I suppose pain could be coincidental and unrelated to meds, but seems unlikely.
I'm also worried about the possibility of switching out one drug at a time from the regimen to see if it helps (which seems like the next likely course of action). Is there a danger of exhausting the pharmaceutical arsenal too quickly by doing that?
(By the way, the thrilling part is that the original regimen improved my CD4/VL counts dramatically.)
Response from Dr. Henry
Wow-an interesting and challenging situation (patients don't like to hear that!). Your condition would be very unusual to be due to the HIV drugs though I believe it could happen. I have seen early herpes zoster present like that or have a flare-up along an old zoster site in the setting of immune reconstitution. One has to be careful starting/stopping Sustiva due to risk for resistance. I often try switching off one drug at a time to try and pin the blame on a drug if no other cause has been found. I would consider getting a consult for a good neurologist to help sort out. If the drugs seemto be a likely cause I might consider a PI only regimen (double boosted PI )on a trial basis (I have been using that approach more often thus not using NRTIs or NNRTIs). Let us know what happens. KH
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