What are the medical decision making strategies for cervical spasm (cervical muscle spasm)?

From the Guidelines

Medical decision making for cervical spasm should prioritize conservative measures, including physical therapy, NSAIDs, and muscle relaxants, with consideration of botulinum neurotoxin for severe cases of cervical dystonia, as supported by the most recent guidelines 1. When managing cervical spasm, it is essential to consider the underlying cause, which may include muscle strain, poor posture, stress, or underlying cervical pathology. The treatment aims to break the pain-spasm cycle by reducing inflammation and muscle tension.

• Conservative measures should include:
  • NSAIDs like ibuprofen (400-800mg every 6-8 hours) or naproxen (500mg twice daily) for pain and inflammation
  • Muscle relaxants such as cyclobenzaprine (5-10mg three times daily) or methocarbamol (750mg every 6 hours) for 7-10 days
  • Physical therapy focusing on gentle stretching, range of motion exercises, and proper posture
  • Heat therapy for 15-20 minutes several times daily to relax muscles, while ice may reduce acute inflammation
• For severe cases, consider a short course of oral steroids like prednisone (20mg daily for 5-7 days with taper) or trigger point injections with lidocaine or bupivacaine mixed with a corticosteroid.
• In cases of cervical dystonia, botulinum neurotoxin formulations, such as OnaBoNT-A and incoBoNT-A, have similar efficacy and should be considered for treatment, as per the updated guidelines 1.
• If symptoms persist beyond 2-3 weeks or are accompanied by neurological symptoms like weakness, numbness, or radiating pain, further evaluation with imaging studies is warranted to rule out disc herniation, stenosis, or other structural abnormalities, as highlighted in the ACR Appropriateness Criteria for cervical neck pain or cervical radiculopathy 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 Improvement is manifested by relief of muscle spasm and its associated signs and symptoms, namely, pain, tenderness, limitation of motion, and restriction in activities of daily living

The medical decision making strategies for cervical spasm (cervical muscle spasm) include:

• Adjunct therapy: Using cyclobenzaprine hydrochloride tablets as an adjunct to rest and physical therapy
• Short-term treatment: Limiting treatment to short periods (up to two or three weeks) due to lack of evidence for prolonged use
• Monitoring for improvement: Assessing improvement based on relief of muscle spasm and associated signs and symptoms, such as pain, tenderness, limitation of motion, and restriction in activities of daily living 2

From the Research

Medical Decision Making Strategies for Cervical Spasm

The following strategies are based on the available evidence:

• Pharmacological Interventions:
  • Cyclobenzaprine, a muscle relaxant, has been shown to be effective in relieving muscle spasm associated with cervical pain 3, 4, 5.
  • Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), may also be used to relieve pain and inflammation 3, 6.
  • Combination therapy with cyclobenzaprine and ibuprofen may not be superior to cyclobenzaprine alone in adult patients with acute neck and back pain with muscle spasm 3.
• Physical Therapy Interventions:
  • Physical therapy, including electrotherapy, kinesiotherapy, and manual massage, has been found to be effective in treating neck pain patients 7.
  • A combination of these physical therapy methods may be more effective than a single method 7.
• Treatment Outcomes:
  • Significant improvements in patient-rated scales, such as spasm, pain, and medication helpfulness, have been reported with cyclobenzaprine and ibuprofen treatment 3, 4, 5.
  • Physical therapy has been shown to improve quality of life, reduce work absence, and help patients return to normal everyday activities 7.
• Safety and Tolerability:
  • Cyclobenzaprine and ibuprofen have been found to be well tolerated, with common adverse events including fatigue, somnolence, dizziness, and nausea 3, 4, 5.
  • Physical therapy methods have been found to be safe and effective, with no significant adverse events reported 7.