Intensity Of Cramps Research Articles

Pilot testing a stretching regimen for prevention of night time nocturnal leg cramps

Nocturnal leg cramps (NLC) are painful, involuntary muscle contractions that affect the quality of sleep. The aim of this study was to examine the feasibility and effectiveness of a stretching regimen in frail older adults aged over 75 years with NLC. The experimental group (n = 15) received an intervention, which they were instructed to perform three daily exercises to stretch the calves and hamstrings. After six weeks, frequency and pain intensity of NLC were both significantly decreased in the experimental group compared to the control group. A paired samples t-test reveals a statistically significant decrease in cramp frequency (t = 2.2, df 28, P = 0.04) and cramp intensity (t = 2.7, df 28, P = 0.01). Therefore, a six-week stretching regimen is likely to reduce the frequency and pain intensity of NLC in frail older adults aged over 75 years.

Gastric administration of garlic powder containing the trpa1- agonist allicin induces specific epigastric symptoms and gastric relaxation in healthy subjects.

TRPA1 is an excitatory ion channel and is involved in sensory processes including thermal nociception and inflammatory pain. The allicin in garlic is a strong activator of the TRPA1 channel. To evaluate the effect of intragastric garlic powder containing allicin on perception, gastric tone, and mechanosensitivity. An infusion-barostat balloon assembly was used for infusion of test solutions, for distension, and to measure proximal gastric compliance and tone. After an initial open label dose finding with 1g, 2g, 3.75g, and 7.5g commercially available garlic powder, a bolus of 2g garlic powder (11mg allicin)/60mL H2 O was considered to induce moderate but constant sensation and was used hereafter in a placebo-controlled, single-dose, double-blind, randomized study in 7 volunteers to evaluate gastric sensation, tone, and mechanosensitivity. Bolus injection of garlic caused immediate epigastric symptoms, mean aggregate symptom scores (AUC in 15minutes) were 106±49 vs. 35±30 after placebo (P=0.01). Garlic induced significant epigastric pressure, stinging, and warmth (P<0.01 vs. placebo), while intensity of cramps, satiety, nausea, and pain was not significantly different to placebo (P>0.05). Garlic induced an immediate, short lived fundic relaxation (balloon volume 627±349mL vs. -145±120mL; P<0.02). No effect of allicin on proximal gastric mechanosensitivity and compliance was observed (NS). Garlic containing allicin induces immediate epigastric symptoms of pressure, stinging, and warmth and induces fundic relaxation but does not influence mechanosensitivity or compliance. TRPA1 is a receptor that is involved in gastric sensation and motility.

Randomised clinical trial: oral taurine supplementation versus placebo reduces muscle cramps in patients with chronic liver disease.

Painful muscle cramps occur in the majority of patients with cirrhosis impacting significantly on quality of life and sleep patterns. They are frequently unrecognised or overlooked. Current management is based on anecdotal evidence or case study reports. To investigate the effect of oral taurine supplementation on frequency, duration, and intensity of muscle cramps in patients with chronic liver disease. Patients with chronic liver disease who experienced three or more muscle cramps/week were enrolled in a double-blinded, randomised control, crossover, taurine dose-variable study. Each participant received either taurine supplementation or placebo for 4weeks then crossed to the alternative arm. Primary outcome data for frequency, duration, and intensity of muscle cramps was recorded by participants. Participants recorded frequency, duration, and location of muscle cramps. Biochemical parameters, including serum taurine and methionine levels, were measured at each time point. Linear mixed models were used to analyse outcomes. Forty-nine patients were enrolled in the study and 30 patients completed the protocol. Participants who were unable to complete the protocol were not included in the final analysis due to the absence of outcome data. The mean age of participants was 54.7years and 70% were males. Oral taurine supplementation increased serum taurine levels (P<0.001). There were no adverse side effects associated with taurine supplementation. Participants receiving 2g taurine/d experienced a reduction in cramp frequency (seven cramps fewer/fortnight, P=0.03), duration (89minutes less/fortnight P=0.03), and severity (1.4 units less on a Likert scale P<0.004) compared to placebo. Oral supplementation with 2g taurine/d results in a clinically significant reduction in the frequency, duration, and intensity of muscle cramps in patients with chronic liver disease. Taurine should be considered as a safe and effective intervention in the management of muscle cramps in individuals with chronic liver disease. This study was registered with the Australian New Zealand Clinical Trials Register: ACTRN12612000289819.

Effects of TRPV1 and TRPA1 activators on the cramp threshold frequency: a randomized, double-blind placebo-controlled trial.

Previous data indicate that a strong sensory input from orally administered TRPV1 and TRPA1 activators alleviates muscle cramps in foot muscles by reducing the α-motor neuron hyperexcitability. We investigated if TRP activators increase the cramp threshold frequency of the medial gastrocnemius. We randomly assigned 22 healthy male participants to an intervention (IG) and a control group (CG). While participants of the IG ingested a mixture of TRPV1 and TRPA1 activators, the CG received a placebo. We tested the cramp threshold frequency (CTF), the cramp intensity (EMG activity), and the perceived pain of electrically induced muscle cramps before (pre), and 15min, 4, 8, and 24h after either treatment. We further measured the maximal isometric force of knee extensors at pre, 4, and 24h to assess potential side-effects on the force output. When we included all measurement time points, no group-by-time interaction was observed for the CTF. However, when only pre and 15min values were incorporated, a significant interaction, with a slightly greater CTF increase in IG (3.1±1.5) compared to the CG (2.0±1.5), was observed. No significant group by time interaction was found for the cramp intensity, the perceived pain, and the maximal isometric force. Our data indicate that orally administered TRPV1 and TRPA1 activators exert a small short-term effect on the CTF, but not on the other parameters tested. Future studies need to investigate whether such small CTF increments are sufficient to prevent exercise-associated muscle cramps.

Insomnia, muscular cramps and pruritus have low intensity in hemodialysis patients with good dialysis efficiency, low inflammation and arteriovenous fistula.

Insomnia, muscular cramps, pruritus and postdialysis recovery time (RT) are quality-of-life parameters that affect hemodialysis (HD) patients physically and mentally. We included 171 end-stage renal disease patients: 115 on high-flux HD and 56 on online hemodiafiltration (HDF). Patients were asked "How long does it take you to recover from a dialysis session?" and they evaluated intensity (absent, mild, medium and severe) of insomnia, muscular cramps and pruritus in the past 4weeks. We sought associations of RT, insomnia, muscular cramps and pruritus with themselves and age, dialysis vintage, sex, body mass index, hemoglobin, albumin, C-reactive protein (CRP), Daugirdas single-pool Kt/V (Kt/V), ultrafiltration volume, blood processed volume and vascular access type. Insomnia absence correlated with muscular cramps absence (p=0.01), arteriovenous fistula (AVF) presence (p=0.02) and lower CRP (p=0.003). Muscular cramps absence associated pruritus absence (p=0.007) and AVF (p=0.001). Absent pruritus patients were younger (p=0.04), had higher Kt/V (p=0.01) and more AVF (p=0.02). Men insomnia was more severe in HD than HDF and albumin related (p=0.007), while CRP was lower in absent pruritus. Women insomnia associated with muscular cramps (p=0.04) and vascular access (p=0.03), as was pruritus (p=0.03). RT had no relations with any parameter. HD patients with AVF have less insomnia, muscular cramps and pruritus. Insomnia is associated with muscular cramps and inflammation. Pruritus is worse in older patients, is diminished with increased dialysis efficiency and is associated with higher CRP in men. There is no difference between HD and HDF patients, except more severe insomnia for HD in men.

Impact of a designed isotonic exercise program on pain intensity of muscle cramps in legs of patients undergoing hemodialysis; a randomized clinical trial

Introduction: Pain due to muscle cramp is a common complication during hemodialysis. Studies have shown that exercise can reduce pain and fatigue through reduction of muscle stiffness and sensitivity, and improvement blood flow.

A Study To Assess The Effect of Intradialytic Stretching Exercise on Muscle Cramps among Patients Undergoing Haemodialysis in A Selected Hospital, at Bangalore.

Background of the study: Clients undergoing dialysis do not walk a pleasant road. Yet during their devastating experience of dialysis sessions, Muscle cramps may be the cause further pain. The stretching exercise can be given to the patients undergoing haemodialysis to prevent the outbreak of muscle cramps which may the result of fluid loss during the session. The effectiveness of stretching exercise is measured through modified numerical intensity scale, duration and frequency. Objectives: To assess the effect of intradialytic stretching exercise on muscle cramps among patients undergoing haemodialysis. Design and Methods: Approach: An evaluation approach. Design: This study was only experimental design. Setting: In haemodialysis unit of Rangadore Memorial Hospital at Bangalore. Participants: 60 patients who fulfilled selection criteria were included in the study. Pre-Assessment: The tool was developed by preparation of Modified Numerical Intensity Scale, Duration, and Frequency content validity of the stool was established by giving to professional experts. Intervention: The personal data was assessed by demographic and clinical questionnaires. The stretching exercise was administered during haemodialysis on muscle cramps. Post-Assessment: Assessing the effect of stretching exercise on muscle cramps with the help of Modified Numerical Intensity Scale, Duration and Frequency. Results: 1.The study reveals that paired't' values 3.19 (p<0.01) and 5.8 (p<0.001) should that there is a significant difference between the intensity scale scores during third and fourth hours in the experimental and control groups respectively. 2. The study showed that there is no significant association between any patient variable and the intensity, duration and frequency of cramps during third and fourth hours in experimental group. 3. In the control group, intensity of muscle cramps showed significant association with previous experience of muscle cramps and use of membrane stabilizing agents. Conclusions: The study concluded the findings suggest that the exercise was effective in terms of reduction in the intensity, duration and frequency of muscle cramps in the experimental group. The nurse has to be alert to spend time to assess risk factors for muscle cramps, develops nursing strategies to prevent or reduce the incidence of muscle cramps during dialysis.

The effect of Vitamin D and calcium plus Vitamin D on leg cramps in pregnant women: A randomized controlled trial.

Background:This study intended to determine the effects of Vitamin D and calcium-Vitamin D in treating leg cramps in pregnant women.Materials and Methods:This study was conducted as a double-blind randomized controlled clinical trial on 126 participants, 18–35-year-old pregnant women with a minimum of two leg cramps per week who were referred to health-care centers in Tabriz-Iran in 2013. The participants were allocated to three 42 member groups using a randomized block design. For 42 days, the intervention groups took a 1000 unit Vitamin D pill or 300 mg calcium carbonate plus a 1000 unit Vitamin D pill, and the control group received a placebo pill every day. The participants were evaluated with regard to the frequency, length, and pain intensity of leg cramps during the week before and during the 3rd and 6th week of the intervention. The ANCOVA and repeated measurement test were used to analyze the data.Results:Results showed that controlling for the effects before the intervention, calcium-Vitamin D, and Vitamin D supplements had no effect on the frequency, length, and pain intensity of leg cramps.Conclusion:The results of this study showed that the calcium-Vitamin D and the Vitamin D supplements have no effect on the frequency, length, and pain intensity of leg cramps during the 6 weeks of the study.

National Study of Muscle Cramps in ALS in the USA

The objective of this study was to describe muscle cramps in an US sample of amyotrophic lateral sclerosis (ALS) patients. Utilizing an anonymous web based questionnaire we queried ALS patients regarding the severity, frequency, time-course, treatment of muscle cramps and their relationship to pain. The survey had 282 respondents with 92% reporting that they had cramps. For 20% of the sample, cramps were stated to be the presenting ALS symptom. Cramp severity was rated at a mean of 5.2/10 and the mean cramp frequency was 5.3 cramps per day. Cramp intensity and frequency did not correlate with duration or severity of ALS. Pain as measured with the Patient Reported Outcome Measurement Information System (PROMIS) pain scales was not statistically different from the US general population. Cramp severity and frequency significantly and positively correlated with the PROMIS pain scales. Patients with more severe cramps were more likely to use prescription medications for their cramps compared to patients with milder symptoms. Treatments directed at cramps were tried by 57%. In conclusion, cramps are a common symptom in ALS and it does not correlate with disease duration or severity. The severity of cramps is on average moderate and many patients try treatments.

A review of nocturnal leg cramps in older people.

Nocturnal leg cramps are common and troublesome, especially in later life, and have a significant impact on quality of life, particularly sleep quality. This article reviews the current state of knowledge regarding the diagnosis, frequency, pathophysiology and management of cramps. Recent evidence suggests that diuretic and long-acting beta-agonist therapy predispose to leg cramps. There is conflicting evidence regarding the efficacy of prophylactic stretching exercises in preventing cramps. Quinine remains the only medication proven to reduce the frequency and intensity of leg cramps. However, the degree of benefit from quinine is modest and the risks include rare but serious immune-mediated reactions and, especially in older people, dose-related side effects. Quinine treatment should be restricted to those with severe symptoms, should be subject to regular review and requires discussion of the risks and benefits with patients.

Muscle Cramp Susceptibility Increases Following a Prior Muscle Cramp

Many athletes develop multiple muscle cramps in the same muscle during exercise. This phenomenon may be due to cramp-induced increases in nervous system excitability. The effect of prior cramps on future cramp risk or how long prior cramps affect cramp risk is unknown. PURPOSE: We tested 2 hypotheses: (1) volitionally-induced muscle cramps will decrease cramp threshold frequency (TF) thereby indicating greater cramp risk and (2) cramp TF would be lower 5 minutes post-cramp but return to baseline after 30 minutes. METHODS: A cross-over, counterbalanced, repeated measure experimental design guided the study. Fifteen subjects capable of volitionally inducing a flexor hallucis brevis (FHB) cramp completed the study (11 males, 4 females: age=25±5 y, height=180.8±12.1 cm, mass=85.0±11.8 kg). On 4 days, we measured cramp TF (the lowest electrical stimulation frequency necessary to induce cramp). On day 1, baseline cramp TF was determined by electrically stimulating the tibial nerve (two square-wave bursts, burst duration=1 s, pulse width=1 ms, pulse delay=1 ms, stimulus intensity=80V). Initial burst frequency was 4 Hz. If cramp was not induced, subjects rested 1 min and frequency was increased by 2 Hz. This process continued until a cramp occurred. Subjects rested 10 minutes, volitionally induced a FHB cramp, and rated the volitionally-induced cramp’s intensity (0=weakest cramp, 100=strongest cramp). On testing days 2-4, subjects first voluntarily induced a FHB cramp and then waited either 5 minutes, 30 minutes, or 60 minutes before cramp TF was reassessed. Volitionally-induced cramp amplitude, cramp duration, and perceived intensity were measured each day to ensure consistency of volitionally-induced cramps. RESULTS: Volitionally-induced cramp amplitude (F3,42=1.1, P=0.37), cramp duration (F3,42=0.7, P=0.54), and perceived cramp intensity (F3,42=1.2, P=0.33) were similar each day. Volitionally-induced muscle cramps significantly decreased cramp TF (F2,25=4.5, P=0.02). Baseline cramp TF (18±6 Hz) was higher than the 5 minute (14±6 Hz), 30 minute (14±5 Hz), or 60 minute TF (14±5 Hz, P<0.05). CONCLUSIONS: Prior muscle cramps increase cramp risk for at least 60 minutes. Clinicians should continue treatment interventions to prevent cramps for >60 minutes to decrease the probability of recurrence.

The effect of acupressure on muscle cramps in patients undergoing hemodialysis.

Background:Pain resulting from muscle cramps is one of the most common outcomes of hemodialysis. One of the mechanisms associated with muscle cramps is unnatural muscle metabolism. Because acupressure improves muscle metabolism through the releasing of energy, this study was performed with the purpose of determining the impact of acupressure on muscle cramps.Materials and Methods:This study was a single-blind clinical trial. Accordingly, 64 patients were selected and intensity and frequency of muscle cramps were determined by randomly categorizing them into two groups. The intervention group received 9 sessions of acupressure and the control group received 9 sessions of placebo intervention. The intervention was performed 15 min before hemodialysis in both groups. In both the groups, average intensity of pain and the frequency pain was compared before, after, and 1 month after completion of the intervention.Results:Data analysis revealed that there were no significant statistical differences between the two groups in terms of mean value of intensity (P = 0.586) and frequency (P = 0.780) of muscle cramps before the intervention. We observed a significant difference after completion of intervention sessions (P < 0.001). Moreover, there were no significant differences between mean value of intensity (P < 0.001) and frequency (P = 0.030) of muscle cramps in the control group before, after, and 1 month after the completion of 9 sessions of placebo intervention.Conclusions:Employing acupressure may result in decrease of muscle cramps in patients undergoing hemodialysis.

Interventions for leg cramps in pregnancy.

Interventions for leg cramps in pregnancy.

Cochrane corner commentary: Quinine for muscle cramps

Muscle cramps are sudden and involuntary contractions of one or more muscles, usually in the leg and particularly the calf. They can be a symptom of an underlying condition, such as arteriosclerosis or a side effect of a medication, such as diuretics, but this is unusual and most cases are idiopathic. Studies have found that idiopathic leg cramps are very common, occurring in 33–95% of adults [1]. They are slightly more common in women, are more likely with increasing age, occur in many pregnant women during the last trimester, and around 75% of cramp episodes occur at night [1]. The mean duration per episode is just under 10 min. Quinine, derived from cinchona bark, has traditionally been used as a treatment for this condition, but studies have found conflicting data, both in terms of efficacy and safety. This Cochrane review, which assessed the evidence concerning the effect of quinine on muscle cramps, is therefore very useful for clinicians, particularly family doctors [2]. For studies to be included in the review they had to be ‘‘randomised controlled trials of people of all ages with muscle cramps in any location and of any cause, treated with quinine or its derivatives.’’ This resulted in 23 trials with a total of 1586 participants being included in the review. Most of the studies compared quinine to placebo and the most commonly used dose of quinine used was 300 mg/day, with a range of 200–500 mg. The authors noted that the risk of bias in the trials varied considerably, as although all 23 trials claimed to be randomised, only a minority described randomisation and allocation concealment in adequate details. In terms of efficacy, the main finding was that, compared to placebo, quinine significantly reduced the number of cramps by 28%, the intensity of cramps by 10%, and the number of days when a cramp occurred by 20%. However, the duration of cramp episodes was not significantly affected. With respect to side effects, more people taking quinine experienced minor adverse events

Quinine for muscle cramps.

Muscle cramps can occur anywhere and for many reasons. Quinine has been used to treat cramps of all causes. However, controversy continues about its efficacy and safety. This review was first published in 2010 and searches were updated in 2014. To assess the efficacy and safety of quinine-based agents in treating muscle cramps. On 27 October 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE and EMBASE. We searched reference lists of articles up to 2014. We also searched for ongoing trials in November 2014. Randomised controlled trials of people of all ages with muscle cramps in any location and of any cause, treated with quinine or its derivatives. Three review authors independently selected trials for inclusion, assessed risk of bias and extracted data. We contacted study authors for additional information. For comparisons including more than one trial, we assessed the quality of the evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). We identified 23 trials with a total of 1586 participants. Fifty-eight per cent of these participants were from five unpublished studies. Quinine was compared to placebo (20 trials, n = 1140), vitamin E (four trials, n = 543), a quinine-vitamin E combination (three trials, n = 510), a quinine-theophylline combination (one trial, n = 77), and xylocaine injections into the gastrocnemius muscle (one trial, n = 24). The most commonly used quinine dosage was 300 mg/day (range 200 to 500 mg). We found no new trials for inclusion when searches were updated in 2014.The risk of bias in the trials varied considerably. All 23 trials claimed to be randomised, but only a minority described randomisation and allocation concealment adequately.Compared to placebo, quinine significantly reduced cramp number over two weeks by 28%, cramp intensity by 10%, and cramp days by 20%. Cramp duration was not significantly affected.A significantly greater number of people suffered minor adverse events on quinine than placebo (risk difference (RD) 3%, 95% confidence interval (CI) 0% to 6%), mainly gastrointestinal symptoms. Overdoses of quinine have been reported elsewhere to cause potentially fatal adverse effects, but in the included trials there was no significant difference in major adverse events compared with placebo (RD 0%, 95% CI -1% to 2%). One participant suffered from thrombocytopenia (0.12% risk) on quinine.A quinine-vitamin E combination, vitamin E alone, and xylocaine injections into gastrocnemius were not significantly different to quinine across all outcomes, including adverse effects. Based on a single trial comparison, quinine alone was significantly less effective than a quinine-theophylline combination but with no significant differences in adverse events. There is low quality evidence that quinine (200 mg to 500 mg daily) significantly reduces cramp number and cramp days and moderate quality evidence that quinine reduces cramp intensity. There is moderate quality evidence that with use up to 60 days, the incidence of serious adverse events is not significantly greater than for placebo in the identified trials, but because serious adverse events can be rarely fatal, in some countries prescription of quinine is severely restricted.Evidence from single trials suggests that theophylline combined with quinine improves cramps more than quinine alone, and the effects of xylocaine injections into gastrocnemius are not significantly different to quinine across all outcomes. Low or moderate quality evidence shows no significant difference between quinine and vitamin E or quinine and quinine-vitamin E mixture. Further research into these alternatives, as well other pharmacological and non-pharmacological treatments, is thus warranted.There is no evidence to judge optimal dosage or duration of quinine treatment. Further studies using different dosages and measurement of serum quinine levels will allow a therapeutic range to be defined for muscle cramp. Because serious adverse events are not common, large population studies are required to more accurately inform incidence. Longer lengths of follow-up in future trials will help determine the duration of action following cessation of quinine as well as long-term adverse events. The search for new therapies, pharmacological and nonpharmacological, should continue and further trials should compare vitamin E, quinine-vitamin E combination, and quinine-theophylline mixture with quinine.

The effect of gabapentin on muscle cramps during hemodialysis: A double-blind clinical trial

Hemodialysis-associated muscle cramps (HAMC) are a common complication during hemodialysis (HD) sessions. A number of pharmacologic agents have been evaluated to prevent and or diminish HAMC; however, none of them has an established role. To the best of our knowledge, this is the first study to evaluate the possible effect of gabapentin on HAMC. In a double-blinded clinical trial, we compared the possible effect of gabapentin with a placebo in prevention and or diminishing episodes of HAMC in HD patients who had experienced frequent intradialytic muscle cramps. At first, placebo was given before each dialysis session for four weeks and then, after a two-week washout period, 300 mg of gabapentin was given before each dialysis session for four weeks to verify the effect of gabapentin on HAMC. Overall, 15 patients (seven men and eight women; mean age, 52.02 years) with frequent intradialytic muscle cramps were enrolled in the study. The incidence of symptomatic muscle cramp decreased in the gabapentin group compared with the placebo group, with a significant difference between them (P = 0.001). The intensity of muscle cramps also decreased in the gabapentin group (P = 0.001). There was no significant association between HAMC in male and female patients (P = 0. 397), mean age of HD patients (P = 0.226) and cause of end-stage renal disease (P = 0.551). According to the results of our study, gabapentin prescription before each HD session significantly reduced the frequency and the intensity of muscle cramps during HD without any major side-effects.

Significant and serious dehydration does not affect skeletal muscle cramp threshold frequency

ObjectiveMany clinicians believe that exercise-associated muscle cramps (EAMC) occur because of dehydration. Experimental research supporting this theory is lacking. Mild hypohydration (3% body mass loss) does not alter threshold frequency...

Magnesium for skeletal muscle cramps

Skeletal muscle cramps are common and often presented to physicians in association with pregnancy, advanced age, exercise or disorders of the motor neuron (such as amyotrophic lateral sclerosis). Magnesium supplements are marketed for the prophylaxis of cramps but the efficacy of magnesium for this indication has never been evaluated by systematic review. To assess the effects of magnesium supplementation compared to no treatment, placebo control or other cramp therapies in people with skeletal muscle cramps. We searched the Cochrane Neuromuscular Disease Group Specialized Register (11 October 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (2011, Issue 3), MEDLINE (January 1966 to September 2011), EMBASE (January 1980 to September 2011), LILACS (January 1982 to September 2011), CINAHL Plus (January 1937 to September 2011), AMED (January 1985 to October 2011) and SPORTDiscus (January 1975 to September 2011). Randomized controlled trials (RCTs) of magnesium supplementation (in any form) to prevent skeletal muscle cramps in any patient group (i.e. all clinical presentations of cramp). We considered comparisons of magnesium with no treatment, placebo control, or other therapy. Two authors independently selected trials for inclusion and extracted data. Two authors assessed risk of bias. We attempted to contact all study authors and obtained patient level data for three of the included trials, one of which was unpublished. All data on adverse effects were collected from the included RCTs. We identified seven trials (five parallel, two cross-over) enrolling a total of 406 individuals amongst whom 118 cross-over participants additionally served as their own controls. Three trials enrolled women with pregnancy-associated leg cramps (N = 202) and four trials enrolled idiopathic cramp sufferers (N = 322 including cross-over controls). Magnesium was compared to placebo in six trials and to no treatment in one trial.For idiopathic cramps (largely older adults presumed to have nocturnal leg cramps), differences in measures of cramp frequency, magnesium versus placebo, were small, not statistically significant, and without heterogeneity (I(2) = 0%). This includes the primary endpoint, percentage change from baseline in the number of cramps per week at four weeks (-3.93%, 95% confidence interval (CI) -21.12% to 13.26%, moderate quality evidence) and the difference in the number of cramps per week at four weeks (0.01 cramps/week, 95% CI -0.52 to 0.55, moderate quality evidence). The percentage of individuals experiencing a 25% or better reduction in cramp rate from baseline was also no different, being 8% lower in the magnesium group (95% CI -28% to 12%, moderate quality evidence). Similarly, no statistically significant difference was found at four weeks in measures of cramp intensity (moderate quality evidence) or cramp duration (low quality evidence).Meta-analysis was not possible for trials of pregnancy-associated leg cramps. The single study comparing magnesium to no treatment failed to find statistically significant benefit on a three-point ordinal scale of overall treatment efficacy. The two trials comparing magnesium to placebo differed in that one trial found no benefit on frequency or intensity measures while the other found benefit for both.Withdrawals due to adverse events were not significantly different than placebo. While we could not determine the number of subjects with minor adverse events, studies of oral magnesium generally described potential side effects as similar in frequency to placebo. It is unlikely that magnesium supplementation provides clinically meaningful cramp prophylaxis to older adults experiencing skeletal muscle cramps. In contrast, for those experiencing pregnancy-associated rest cramps the literature is conflicting and further research in this patient population is needed. We found no randomized controlled trials evaluating magnesium for exercise-associated muscle cramps or disease state-associated muscle cramps (for example amyotrophic lateral sclerosis/motor neuron disease).

Oral magnesium for relief in pregnancy‐induced leg cramps: a randomised controlled trial

Leg cramps are common in pregnant women. Currently, there is no standard treatment for pregnancy-induced leg cramps. The objective of this study was to evaluate the therapeutic efficacy of oral magnesium in pregnant women with leg cramps. This double-blinded, randomised, placebo-controlled trial included 86 healthy pregnant women, 14-34 weeks of gestation who had leg cramps at least twice per week. The study period was 4 weeks. Eighty women completed the study. Forty-one women were assigned to magnesium bisglycinate chelate (300 mg per day) and 39 women to placebo. Details of leg cramps were recorded before beginning the treatment and the fourth week of study. Outcome measure was the reduction of cramp frequency after treatment and cramp intensity measured by 100-mm visual analogue scale. Fifty per cent reduction of cramp frequency was significantly higher in the magnesium group than the placebo group (86.0% vs. 60.5%, P=0.007). The 50% reduction of cramp intensity was also significantly higher in the treatment group than in the placebo group (69.8% vs. 48.8%, P=0.048). There were no significant differences between the two groups in terms of side effects such as nausea and diarrhoea. These results demonstrated that oral magnesium supplement can improve the frequency and intensity of pregnancy-induced leg cramps. Therefore, oral magnesium may be a treatment option for women suffering from pregnancy-induced leg cramps.

PO.16 Is quinine useful in muscle cramps? A Cochrane meta-analysis

BackgroundGlobal controversy on the efficacy and safety of quinine for muscle cramps (banned in USA, widely prescribed in UK), led us to conduct a meta-analysis of all trials comparing quinine...