From the Guidelines
A comprehensive workup for muscle cramps, aches, and spasms should begin with a thorough medical history and physical examination to identify potential causes, as well as initial laboratory tests including complete blood count, comprehensive metabolic panel, thyroid function tests, creatine kinase, and electrolytes, particularly calcium, magnesium, potassium, and sodium 1. The evaluation process should prioritize the identification of underlying conditions that may be contributing to the symptoms, such as electrolyte imbalances, dehydration, or medication side effects. Key considerations in the workup include:
- A thorough medical history to identify potential causes of muscle cramps, aches, and spasms
- Physical examination to assess for signs of underlying conditions
- Initial laboratory tests, including:
- Complete blood count
- Comprehensive metabolic panel
- Thyroid function tests
- Creatine kinase
- Electrolytes (particularly calcium, magnesium, potassium, and sodium)
- Consideration of vitamin D levels, inflammatory markers, and autoimmune panels for persistent symptoms Treatment options may include:
- NSAIDs like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-500mg twice daily) for pain and inflammation
- Muscle relaxants such as cyclobenzaprine (5-10mg three times daily) or baclofen (5-20mg three times daily) for acute spasms
- Topical treatments like menthol creams or lidocaine patches for localized relief
- Non-pharmacological approaches, including gentle stretching, heat or cold therapy, adequate hydration, and proper electrolyte balance
- Physical therapy for chronic cases It is essential to note that muscle cramps often result from electrolyte imbalances, dehydration, overexertion, or medication side effects, while persistent symptoms might indicate underlying neurological, endocrine, or inflammatory conditions requiring further specialized evaluation 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 Improvement is manifested by relief of muscle spasm and its associated signs and symptoms, namely, pain, tenderness, limitation of motion, and restriction in activities of daily living
The workup for muscle cramps, aches, and spasms may include the use of cyclobenzaprine as an adjunct to rest and physical therapy. The primary goal is to provide relief from muscle spasm and its associated symptoms, such as:
- Pain
- Tenderness
- Limitation of motion
- Restriction in activities of daily living Cyclobenzaprine should be used for short periods (up to two or three weeks) due to the lack of evidence for its effectiveness in prolonged use 2.
From the Research
Causes of Muscle Cramps, Aches, and Spasms
- Muscle cramps can be caused by various factors, including physiologic states such as pregnancy and exercise, medical and neurologic conditions, medications like diuretics and statins, and peripheral nerve hyperexcitability syndromes 3
- Muscle cramps are often part of the spectrum of normal human physiology and can be associated with a wide range of acquired and inherited causes 4
- Electrolyte imbalances, such as abnormalities in sodium, potassium, calcium, phosphorus, and magnesium levels, can also contribute to muscle cramps and spasms 5, 6
Treatment and Management
- Treatment options for muscle cramps are limited, but recent studies have shown that mexiletine could be a safe and efficient alternative for patients with amyotrophic lateral sclerosis 3
- A practical approach to muscle cramps and contractures includes identifying the cause, determining whether the cramps are exercise-induced, idiopathic, or symptomatic, and selecting an appropriate diagnostic and treatment plan 4
- Maintaining homeostasis of potassium and magnesium is critical in managing comorbid conditions, and various therapies can help retain these ions 6
Related Conditions
- Contractures can mimic muscle cramps and are defined as shortenings of the muscle resulting in an inability of the muscle to relax normally 4
- Electrolyte imbalances can result in elevated or diminished levels, interfering with normal physiological activities and potentially leading to life-threatening consequences 5, 6