A 58-year-old woman, who three years ago underwent stent placement in her left anterior descending for unstable angina, comes for an annual evaluation for secondary prevention. She is taking simvastatin 40 mg per day, metoprolol tartrate 25 mg twice a day, and aspirin 81 mg per day. She denies angina but does state that she has had severe thigh and low back pain. She is very physically active. Her other risk factors include hypertension, which is well controlled, and former tobacco abuse. On laboratory testing, she has total cholesterol of 160 mg/dL, triglycerides of 50 mg/dL, HDL cholesterol 75 mg/dL, and LDL cholesterol 75 mg/dL with a non-HDL cholesterol of 85 mg/dL. Her creatine kinase is normal.
Which of the following are true regarding statin-associated myalgia?