What are the recommended topical treatments for muscle spasm?

Recommended Topical Treatments for Muscle Spasm

Over-the-counter topicals containing camphor or menthol in combination with methyl salicylate (such as Ultra Strength Bengay Cream, Ultra Strength Bengay Pain Relieving Patch, and Icy Hot) are recommended as first-line topical treatments for muscle spasm. 1

First-Line Topical Treatments

• Methyl salicylate (10%) acts as a topical analgesic and helps reduce pain associated with muscle spasms 2
• Menthol-containing products should be applied to the affected area 1-2 times daily for adults and children 12 years and older 3
• Combination products containing methyl salicylate and menthol provide dual action through analgesic effects and promoting vasodilation, which may help relieve muscle spasm 4, 5
• These products are widely available over-the-counter and have demonstrated effectiveness in reducing muscle pain in real-world clinical settings 4

Second-Line Topical Treatments

• Diclofenac 1% gel (over-the-counter) can be used when first-line treatments are ineffective 1
• Capsaicin cream (0.025% to 0.075%) applied to affected areas 3-4 times daily for adults and children 18 years and older 6
  • Patients should be warned about initial stinging and burning sensations 1
  • Capsaicin works through desensitization of TRPV1 receptors, leading to decreased release of pain-transmitting neurotransmitters 1

Compounded Topical Options

For cases resistant to over-the-counter treatments, compounded topical medications may be considered:

• Compounded lidocaine cream or ointment (4-5%) can be effective for muscle pain 1
  • Lidocaine patches (4% OTC or 5% prescription) may be more effective than creams as they deliver medication gradually over 12-24 hours 1
• Compounded amitriptyline-ketamine mixture applied up to 3 times daily 1
  • This combination blocks sodium channels and antagonizes N-methyl-D-aspartate receptors in peripheral nociceptive afferents 1
• Compounded gabapentin 6% ointment 1

Application Recommendations

• Apply a thin layer of topical medication directly to the affected muscle area 6, 3
• Gently massage the product into the skin until fully absorbed 6
• Wash hands thoroughly after application unless treating the hands 6
• For optimal results, apply 3-4 times daily as directed 6
• A warm pad may be placed on the affected area for 10 minutes after application of certain products (like menthol-containing preparations) to enhance effectiveness 3

Clinical Considerations and Cautions

• Topical treatments should be tried for at least 4 weeks to properly assess efficacy before switching to another option 1
• Avoid applying topical products to broken or irritated skin 4
• Common adverse reactions include local pruritus (0.48%), burning sensation (0.28%), and irritation at the application site (0.2%) 4
• For patients with persistent or severe muscle spasms not responding to topical treatments, consider systemic treatments or referral to a pain specialist 1
• Topical analgesics are generally safer than systemic medications as they have fewer systemic side effects 1

Evidence of Effectiveness

• In a multicenter real-world study, compound methyl salicylate liniment significantly relieved soft tissue pain with a 47.11% pain relief rate 4
• A randomized, double-blind study showed that topical cream containing analgesic ingredients was effective for treating muscle pain with significant decreases in pain levels compared to placebo 7
• Topical trolamine salicylate cream has been shown to reduce the duration and severity of muscular soreness caused by exercise 8