(7) The aching, dragging pain in the back of the neck common in poorly-nourished, nervous women and in other cases of neurasthenia, the so-called pain of nervous exhaustion, is myalgia. It is felt chiefly during fatigue, is present in the erect posture, and is almost always relieved when the patient lies down. It is referred sometimes to the base of the skull, sometimes to the whole of the back of the neck, but more commonly to the spinal region just above the level of the upper borders of the scapula, and constitutes a harassing symptom of the cases in which it occurs. In this connection it must be pointed out that many of the pains of that obscure condition to which the term spinal irritation has been vaguely applied are myalgic.
Myalgia manifests itself furthermore in the limbs, in the diaphragm, and occasionally in the muscles of the eyeballs.
The COURSE of the attack is in the simpler forms acute and transient; it frequently, however, becomes chronic, and not uncommonly presents the characters of the chronic form from the beginning. Again, it sometimes attacks in succession several muscles or groups of muscles, and in by far the greater number of individuals it shows a tendency to recur from time to time.
DURATION.—The duration of acute attacks is usually brief, lasting from a few hours to several days; that of the chronic form is indefinite, tending to last years, sometimes, under unfavorable circumstances, a lifetime, with varying periods of exacerbation and remission, which are, after the disease is fully established, much influenced by the phases of the weather.
The TERMINATION of acute myalgia is commonly in full recovery, but the tendency to subsequent attacks is to be borne in mind, and guarded against by the exercise of wholesome precautions in the matter of hygiene. Neglected cases of chronic myalgia not rarely terminate in permanent alterations of the muscular structure, with loss of contractile power and rigidity, with or without atrophy.
COMPLICATIONS.—In the acute forms there are no complications, properly so called. In the more severe cases of the chronic form there is danger of nutritive changes in the tissues entering into the formation of joints, and loss of function from want of use.
SEQUELS.—There are no sequels other than those just pointed out.
PATHOLOGY AND MORBID ANATOMY.—As indicated by the various names by which myalgia has been known, the principal theories advanced to account for the morbid manifestations are three in number: (1) that the malady is a rheumatism of the muscles; (2) a form of neuralgia; (3) an inflammation.
(1) Muscular Rheumatism.—That this affection should be popularly associated with rheumatism is not surprising when the character of the pain is regarded, its aggravation on movement, and the temporary or permanent crippling which it occasions; especially when we call to mind the exceedingly vague and indefinite ideas which prevail in regard to rheumatism. But that it should be looked upon, far and wide, among physicians as a form of rheumatism, and described as such in the systematic works—that it should be regarded as due to the same causes as rheumatism and treated from that point of view—is certainly as remarkable as it is misleading.
Let us look at the facts. Nothing is easier: the two affections are under our daily observation side by side; in this climate and among working people few maladies are more common.