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Palliative cancer care - pain - Management
How should I manage muscle spasm?
- Consider whether there is a treatable underlying cause.
- Try simple measures (such as heat pad, massage, relaxation).
- Consider transcutaneous electric nerve stimulation over the trigger point if the pain is myofascial.
- If trigger points are multiple or the muscle spasm is widespread, consider a muscle relaxant — diazepam or (less preferred) baclofen:
- Several different doses of diazepam have been suggested by experts. These range from 2–10 mg at night to 2–5 mg three times a day; the higher doses may be helpful if there is co-existing anxiety. The dose may need to be reduced depending on clinical response.
- The suggested dose of baclofen to treat muscle spasm is 5–10 mg three times a day. However, baclofen should be titrated slowly, which may limit its usefulness in people requiring palliative care.
- Choice of drug will also depend on any other actions (for example, diazepam may be more appropriate for people with co-existing anxiety) and potential for adverse effects. For more detail, see the prescribing information sections on Baclofen and Diazepam.
- If these measures are not effective, or there are only a few trigger points, consider referral. Other drugs or injection of trigger points with local anaesthetic may be considered in secondary care.
In depth
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