From the Guidelines
Muscle cramps are common in patients with liver disease, particularly in those on diuretic treatment for ascites, and are characterized by painful involuntary muscle contractions that adversely influence the quality of life. According to the 2021 practice guidance by the American Association for the Study of Liver Diseases 1, the exact mechanisms by which muscle cramps occur remain unclear. However, some key points to consider include:
- Muscle cramps may be caused or exacerbated by diuretic therapy, particularly in patients with cirrhosis and ascites
- Correction of electrolyte alterations, such as hypokalemia and hypomagnesemia, may help alleviate muscle cramps
- Medications such as baclofen, albumin, orphenadrine, and methocarbamol have been proposed for the treatment of muscle cramps in patients with cirrhosis
- Quinidine has also been shown to be effective in treating muscle cramps, but its use may be limited by toxicities such as diarrhea Some potential treatment options for muscle cramps include:
- Baclofen, which can be started at a dose of 10 mg/day and increased weekly by 10 mg/day up to 30 mg/day 1
- Albumin, which can be administered at a dose of 20-40 g/week 1
- Orphenadrine and methocarbamol, which have been proposed as alternative treatments for muscle cramps in patients with cirrhosis 1 It is essential to note that the treatment of muscle cramps should be individualized and based on the underlying cause and severity of symptoms, as well as the patient's overall medical condition and response to treatment.
From the Research
Definition and Characteristics of Muscle Cramps
- Muscle cramps are characterized by involuntary, painful, visible contraction of a muscle (or a part of muscle) and are always associated with irregular repetitive firing of motor unit action potentials (200 à 300 Hz) which is caused by hyperexcitability of intramuscular terminal motor axons 2.
- They are painful, sudden, involuntary muscle contractions that are generally self-limiting 3.
- Muscle cramps are a common problem characterized by a sudden, painful, involuntary contraction of muscle, which may be distinguished from other muscle pain or spasm 4.
- They are involuntary, painful, spasmodic contractions of the skeletal muscle 5.
Causes and Associations of Muscle Cramps
- Muscle cramps can be associated with a wide range of acquired and inherited causes 3.
- They are often part of the spectrum of normal human physiology and can occur in normal people, but are more common in young people (pregnancy, exercise) and the elderly (50% after 65 years-old) 2.
- Muscle cramps may be a symptom of several conditions, including radiculopathies, Parkinson's disease, hypothyroidism, diabetes mellitus, vascular problems, electrolyte disorders, and metabolic myopathies 5.
- Cramps also may occur as a side effect of certain drugs (eg, lipid-lowering agents, antihypertensives, beta-agonists, insulin, oral contraceptives, alcohol) 5.
Diagnosis and Treatment Approach
- A careful history and examination should allow the physician to determine the significance of cramp, and ENMG and biological tests are needed in cases of severe symptoms and/or abnormal examination 2.
- The main questions for clinicians are: (1) Is this a muscle cramp, a contracture or a mimic? (2) Are the cramps exercise induced, idiopathic or symptomatic? (3) What is/are the presumed cause(s) of symptomatic muscle cramps or contractures? (4) What should be the diagnostic approach? and (5) How should we advise and treat patients with muscle cramps or contractures? 3.
- Treatment options are guided both by experience and by a limited number of therapeutic trials, and quinine sulfate is an effective medication, but the side-effect profile is worrisome 4.
- Therapy should focus on preventing premature fatigue by means of appropriate nutrition and adequate training 5.