Somatosensory amplification, depression, anxiety and pain in statin intolerant patients

Abstract

Background: Lipid management with statins is one of the mainstays of treatment for atherosclerotic cardiovascular disease. Statins are often discontinued by patients secondary to muscle-related complaints independent of elevations in creatine kinase. It has also been suggested that there is a link between mental health disorders and noncompliance. The associations between negative affect and somatization reported as medication-related side effects requires further clarification. One possible cause of statin discontinuation is perceived myopathy secondary to somatization.Objective: This study examines the relationship between affect in statin tolerant and statin intolerant (SI) groups.Methods: This study incorporated patients unable to tolerate at least two different statins (any statin or dosage prescribed) due to side effects or abnormal laboratory markers. Patients completed The Depression Anxiety Stress Scales, the McGill Pain Questionnaire, and the Somatosensory Amplification Scale.Results: There were 20 statin tolerant (ST) patients and 13 SI patients (n=36). There was a significant difference between SI and ST groups, respectively, in age (63 vs. 70 years, p=0.04), total cholesterol (204 vs.136, p <0.01), and LDL cholesterol (129 vs. 136, p < 0.05). There were no significant differences between ST and SI groups for somatic pain, affective pain, somatosensory amplification, depressive symptoms, anxiety symptoms, and stress scores. Conclusion:Our study suggests the discrepancy between statin intolerance in clinical trials and clinical practice cannot be explained solely by somatosensory amplification, anxiety, depression or pain disorders. Nevertheless, an affective and/or anxiety disorder will likely augment the pain perception and somatization in a SI patient.