From the Guidelines
Treatment for muscle spasms should prioritize botulinum toxin for patients with focal spasticity that is painful, impairs function, reduces the ability to participate in rehabilitation, or compromises proper positioning or skin care, as recommended by the most recent guidelines 1.
Non-Pharmacological Approaches
- Rest the affected muscle and apply heat or cold therapy for 15-20 minutes several times daily
- Gentle stretching and massage can help relax the muscle fibers
- Physical therapy focusing on strengthening and flexibility exercises is beneficial for chronic or recurrent spasms
Medication Approaches
- Over-the-counter medications like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily) can reduce inflammation and pain
- Muscle relaxants such as cyclobenzaprine (5-10mg three times daily), methocarbamol (750mg every 4 hours), 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
- Botulinum toxin is effective in treating upper and lower limb spasticity in adults, improving passive function and possibly active function 1
Additional Considerations
- Staying hydrated and maintaining proper electrolyte balance, particularly magnesium, potassium, and calcium, can prevent muscle cramping
- Addressing the underlying cause of muscle spasms, such as nerve irritation, dehydration, electrolyte imbalances, or overuse, is essential for effective treatment
- Topical treatments like menthol creams or lidocaine patches can provide localized relief for muscle spasms 1
From the FDA Drug Label
Cyclobenzaprine hydrochloride tablets, USP are indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions.
The treatment options for muscle spasms include cyclobenzaprine as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions 2.
- Cyclobenzaprine should be used only for short periods (up to 2 or 3 weeks) because adequate evidence of effectiveness for more prolonged use is not available.
- It is ineffective in muscle spasm due to central nervous system disease 2.
From the Research
Treatment Options for Muscle Spasms
- Medications:
- Cyclobenzaprine, a muscle relaxant, has been shown to be effective in relieving muscle spasms associated with acute low back pain 3, 4, 5.
- Baclofen, another muscle relaxant, has been found to be effective in treating spasticity, particularly in patients with multiple sclerosis 6, 7.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen may also be used in combination with muscle relaxants to relieve muscle spasms 3.
- Alternative Therapies:
- Botulinum toxin type A injections have been used to treat focal spasticity and muscle spasms, particularly in patients with spinal cord injury 6.
- Rehabilitation programs, including physical therapy and functional electrical stimulation, may also be beneficial in managing muscle spasms and improving locomotor function 6.
Efficacy and Safety of Treatment Options
- Cyclobenzaprine has been found to be effective in relieving muscle spasms, with a rapid onset of action and few serious adverse experiences 4, 5.
- Baclofen has been shown to be effective in treating spasticity, but may be associated with more weakness compared to tizanidine 7.
- The safety and efficacy of other skeletal muscle relaxants, such as carisoprodol, orphenadrine, and tizanidine, are less well established, with limited or inconsistent data available 7.