What are the treatments for muscle spasms?

Treatment Options for Muscle Spasms

Cyclobenzaprine is recommended as an adjunct to rest and physical therapy for relief of acute, painful muscle spasms for short periods (up to 2-3 weeks). 1

First-Line Treatments

Non-Pharmacological Approaches

• Physical measures:
  • Stretching exercises for affected muscles - immediate stretching of the affected muscle during acute cramp 2
  • Heat therapy: Apply heat to relax muscles and increase blood flow 2, 3
    • Heat increases blood flow, metabolism, and elasticity of connective tissues
    • Heat-wrap therapy provides short-term pain relief 3
  • Cold therapy: Particularly effective for spasticity from upper motor neuron lesions 4
    • Reduces pain, blood flow, edema, inflammation, and muscle spasm 3
  • Massage of the cramping muscle 2
  • Regular physical activity to improve circulation and muscle conditioning 2
  • Proper hydration and electrolyte balance 2, 5
    • Consumption of carbohydrate-electrolyte beverages may delay onset of exercise-associated muscle cramps 5

Pharmacological Approaches

1. Muscle relaxants:

   • Cyclobenzaprine: 5-10 mg three times daily (FDA-approved) 1
     • Acts primarily within central nervous system at brain stem level
     • Reduces tonic somatic motor activity
     • Use only for short periods (2-3 weeks)
     • Not effective for spasticity from cerebral or spinal cord disease
   • Other options: diazepam, lorazepam, metaxalone 6

2. For persistent cramps:

   • Baclofen: Starting at 10 mg/day with weekly increases up to 30 mg/day 2

Specific Clinical Scenarios

Heat Cramps (Exercise-Associated)

• Rest in cool environment
• Drink electrolyte-carbohydrate mixture (juice, milk, or commercial sports drinks)
• Stretching, icing, and massaging the painful muscles 6
• Resume exercise only after symptoms have completely resolved

Muscle Spasms in Specific Conditions

• Coronary spasm:

  • Calcium channel blockers (verapamil 240-480 mg/day, diltiazem 180-360 mg/day, or nifedipine 60-120 mg/day)
  • Nitrates (may be combined with calcium channel blockers for very active disease)
  • Alpha-receptor blockers for refractory cases 6

• Gastrointestinal smooth muscle spasm:

  • Antimuscarinics: dicycloverine hydrochloride, propantheline bromide, hyoscine butylbromide
  • Hyoscine butylbromide may be more effective when given intramuscularly for long-term home use 6

Special Considerations

Elderly Patients

• Cyclobenzaprine plasma concentrations are generally higher in elderly individuals
• Mean steady-state AUC values approximately 1.7-fold higher in elderly (≥65 years) compared to younger adults
• Elderly males show the highest increase (approximately 2.4-fold) 1

Hepatic Impairment

• Cyclobenzaprine plasma concentrations are generally higher in patients with hepatic impairment 1

Duration of Treatment

• Muscle relaxants should be used only for short periods (2-3 weeks) for acute, painful musculoskeletal conditions 1
• Prolonged use is not supported by evidence and rarely warranted as muscle spasm associated with acute conditions is generally of short duration 1

Monitoring

• Regular assessment of symptom frequency and severity
• Monitoring of medication efficacy and side effects
• Periodic laboratory testing for electrolytes if on diuretics 2

When to Refer

• For severe, persistent, or progressive symptoms
• When symptoms are associated with other neurological findings 2
• When first-line treatments fail to provide relief

Remember that muscle spasms are often self-limiting and part of normal human physiology, but can occasionally be associated with progressive systemic or neuromuscular diseases 7.