Cramps

Cramps

Definition • Cramp usually means a spasmodic, painful, involuntary, contraction of skeletal muscle. • A muscle (or even a few fibers of a muscle) that involuntarily (without consciously willing it) contracts is called a "spasm."

• Sometimes it is also defined as an involuntarily and forcibly contracted muscle that does not relax.

• This transient, involuntary episode of pain, is usually sustained for minutes and even up to 10 minutes, and whole muscles or muscle groups go into spasm. • There is a visible or palpable hardening of the involved muscle • Most often cramps involve the calf muscle, thigh muscle, and small muscles of the foot.

Epidemiology • Cramps are extremely common. Almost everyone (one estimate is about 95%) experiences a cramp at some time in their life. • The prevalence increases with age. – About 1/3 of people over age 60, and half those over 80 complain of cramps.

Types

Paraphysiological Cramps • occur in healthy people in response to a physiological stimulus. • Common during vigorous activity. • They are thought to be the result of hydroelectrolyte imbalance following repeated and chronic use of the same muscle group producing increased excitation of the neuromuscular nerve endings

• Also common to pregnancy, particularly the third trimester. • may also occur in healthy individuals as a result of a sustained posture over a prolonged period of time.

Symptomatic cramps

Drugs causing cramps • In a study of 70 patients in general practice who were prescribed quinine for cramps, 37 (53%) were also taking drugs known to cause cramps. Implicated drugs include: • Salbutamol and terbutaline • Raloxifene • Opiate withdrawal • Diuretics cause electrolyte loss • Nifedipine • Phenothiazines • Penicillamine • Nicotinic acid

Idiopathic cramps • this represents the largest group of causes of cramps • Familial forms exist which appear to have an autosomal dominant mode of transmission.

What are the symptoms of common muscle cramps? How are they diagnosed?

• Characteristically, a cramp is painful, often severely so. Usually, the sufferer must stop whatever activity is under way and seek relief from the cramp; the person is unable to use the affected muscle while it is cramping. Severe cramps may be associated with soreness and swelling, which can occasionally persist up to several days after the cramp has subsided. At the time of cramping, the knotted muscle will bulge, feel very firm, and may be tender. • There are no special tests for cramps. Most people know what cramps are and when they have one. If present during a cramp, the doctor, or any other bystander, can feel the tense, firm bulge of the cramped muscle.

Management • Non-drug • Passive stretching and massage of the affected muscle will help ease the pain of an acute attack. • It is thought that regular stretching of the calf muscles throughout the day may help to prevent acute attacks. Some people recommend stretching 3 times daily while others advocated stretching before going to bed. • Using a pillow to raise the feet through the night, or raising the foot of the bed may help to prevent attacks

• Hydration

• One enthusiastic nonscientific recommendation has been to firmly pinch the tissues above the lip, just under the nose, and hold the pinch until the cramp stops (said to be within 15 minutes.) Of course, why this might be effective is uncertain, and no scientific study of this technique has been reported.

• Drug • Quinine- for non-pregnant • Several other drugs have been suggested as possible treatments including diltiazem, verapamil, and naftidrofuryl.