What are the treatment options for muscle spasms?

From the Guidelines

Treatment for muscle spasms should prioritize a combination of rest, physical therapy, and medication, with a focus on addressing underlying causes and promoting muscle relaxation. For immediate relief, applying heat or cold to the affected area can help relax the muscles. Over-the-counter pain relievers like ibuprofen (400-800mg every 6-8 hours) or naproxen (220-440mg twice daily) can reduce inflammation and pain, as supported by studies 1. Muscle relaxants such as cyclobenzaprine (5-10mg three times daily) or baclofen (5-25mg three times daily) may be prescribed for more severe spasms, typically for short durations of 1-2 weeks to avoid dependence. Gentle stretching exercises can prevent recurrence by improving flexibility and blood flow to the muscles. Staying hydrated and maintaining proper electrolyte balance, particularly magnesium and potassium, is important as deficiencies can trigger muscle contractions. Some key points to consider when treating muscle spasms include:

• Addressing underlying causes like poor posture, ergonomic issues, or specific medical conditions is essential, as noted in studies 1.
• Skeletal muscle relaxants have been found to be moderately superior to placebo for short-term pain relief in acute low back pain, with a higher-quality Cochrane review showing RRs for not achieving pain relief of 0.80 (CI, 0.71 to 0.89) at 2 to 4 days and 0.67 (CI, 0.13 to 3.44) at 5 to 7 days 1.
• However, there is only sparse evidence on the efficacy of antispasticity drugs like dantrolene and baclofen for low back pain, with tizanidine being efficacious for acute low back pain in 8 trials 1.
• It is also important to consider the potential adverse events associated with skeletal muscle relaxants, including a higher total number of adverse events (RR, 1.50 [CI, 1.14 to 1.98]) and central nervous system adverse events (RR, 2.04 [CI, 1.23 to 3.37]) compared with placebo 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.

Treatment for muscle spasms: Cyclobenzaprine is indicated for the relief of muscle spasm associated with acute, painful musculoskeletal conditions. It is recommended to be used as an adjunct to rest and physical therapy.

• Key points:
  • Used for acute, painful musculoskeletal conditions
  • Relieves skeletal muscle spasm of local origin
  • Should be used only for short periods (up to two or three weeks) 2
  • Ineffective in muscle spasm due to central nervous system disease 2

From the Research

Treatment Options for Muscle Spasms

• Muscle relaxants such as cyclobenzaprine hydrochloride, carisoprodol, and metaxalone are commonly used to treat muscle spasms 3, 4, 5
• Cyclobenzaprine hydrochloride has been shown to be effective in improving muscle spasm, reducing local pain and tenderness, and increasing range of motion in acute, painful musculoskeletal conditions 3
• The efficacy of cyclobenzaprine hydrochloride is independent of its sedative effects, which are dose related 3, 5
• Carisoprodol and metaxalone also appear to be effective in treating muscle spasms, but carisoprodol's usefulness is mitigated by its potential for abuse 5
• Other treatment options for muscle spasms include physical therapy, pharmacologic treatments, botulinum toxin, surgical treatments, and alternative options 6

Efficacy and Safety of Muscle Relaxants

• Cyclobenzaprine, carisoprodol, orphenadrine, and tizanidine are effective compared to placebo in patients with musculoskeletal conditions 4
• Baclofen, tizanidine, and dantrolene are effective compared to placebo in patients with spasticity 4
• The overall rate of adverse effects between tizanidine and baclofen is similar, but tizanidine is associated with more dry mouth and baclofen with more weakness 4
• Dantrolene, and to a lesser degree chlorzoxazone, have been associated with rare serious hepatotoxicity 4

Clinical Considerations

• Appropriate medication selection based on clinical indications is important when using muscle relaxants 7
• The potential for abuse with carisoprodol is of growing concern, and its use should be carefully considered 5
• Muscle relaxants can be used in combination with analgesic pain management for low back pain due to muscle spasm 5