From the Guidelines
Psychogenic muscle spasms should be managed with a multidisciplinary approach, prioritizing interventions that encourage normal movement patterns and resting postures, as well as addressing underlying psychological factors through anxiety management and distraction techniques, as recommended in the 2020 occupational therapy consensus recommendations for functional neurological disorder 1.
Key Intervention Strategies
- For functional movement symptoms, strategies such as superimposing alternative, voluntary rhythms, using gross rather than fine movements, and discouraging cocontraction or tensing of muscles can be beneficial 1.
- General relaxation techniques, such as diaphragmatic breathing or progressive muscular relaxation, and sensory grounding can help address unhelpful pre-jerk cognitions and movement 1.
- Encouraging optimal postural alignment, even distribution of weight, and grading activity to increase the time that the affected limb is used within functional activities can help manage dystonia 1.
- Engaging the person in tasks that promote normal movement, good alignment, and even weight-bearing can help address functional limb weakness 1.
Additional Considerations
- Anxiety management and distraction techniques can be helpful when undertaking tasks, and video recording interventions can be useful to demonstrate changeability and highlight successes 1.
- Splinting may prevent restoration of normal movement and function, and potential problems with splinting include increasing attention and focus to the area, exacerbating symptoms, and leading to muscle deconditioning 1.
- Removable splints may have an overall positive effect in some cases, but benefits should be balanced against potential harm, and regular monitoring is necessary to empower the person to discontinue use in the event of adverse side effects 1.
From the FDA Drug Label
Cyclobenzaprine hydrochloride tablets are indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions Cyclobenzaprine HCl relieves skeletal muscle spasm of local origin without interfering with muscle function. It is ineffective in muscle spasm due to central nervous system disease.
The answer to psychogenic muscle spasms is that cyclobenzaprine is ineffective in treating muscle spasms due to central nervous system disease, which would include psychogenic causes 2 2.
From the Research
Psychogenic Muscle Spasms
- Psychogenic muscle spasms are a type of movement disorder that can be distinguished from organic muscle spasms by certain clinical features, such as tonic muscle contractions, bilateral asynchronous hemifacial involvement, and lack of the "other Babinski sign" 3.
- Studies have shown that patients with psychogenic hemifacial spasm (HFS) are significantly younger and have more frequently tonic muscle contractions, bilateral asynchronous hemifacial involvement, and isolated lower facial involvement compared to those with organic HFS 3.
- Other features such as suggestibility, distractibility, and periods of unexplained improvements are also commonly observed in patients with psychogenic movement disorders, including psychogenic muscle spasms 3.
Treatment and Management
- Relaxation techniques, such as progressive muscle relaxation, deep breathing, and guided imagery, have been shown to be effective in promoting psychological and physiological states of relaxation and reducing stress 4, 5.
- These techniques can be used to help manage psychogenic muscle spasms, as well as other types of movement disorders, by reducing muscle tension and promoting relaxation 4, 5.
- Other treatment options, such as botulinum toxin and peripheral neurotomies, may also be helpful in managing spasticity and muscle spasms, particularly in cases where the spasms are restricted to a few muscular groups 6.
Diagnosis and Evaluation
- The diagnosis of psychogenic muscle spasms typically involves a thorough clinical evaluation, including a review of the patient's medical history and a physical examination 3.
- The use of internationally approved evaluation scales, such as the Ashworth scale and the muscle spasms scale, can also be helpful in assessing the severity of muscle spasms and monitoring treatment response 6.
- A correct flow-chart to diagnose and treat the patient is mandatory to achieve the best results for each patient according to their spasticity and residual motor ability 6.