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Tapper EB, Trivedi H, Simonetto DA, Patwardhan V, Ospina E, Martinez B, Chen X, Walker S, Nikirk S. The RELAX randomized controlled trial: Stretching versus meditation for nocturnal muscle cramps. Liver Int 2024. [PMID: 38860445 DOI: 10.1111/liv.16007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/25/2024] [Accepted: 05/23/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Muscle cramps are common among persons with cirrhosis and are associated with poor health-related quality of life (HRQOL). Treatment options are limited. We compared stretching or meditation in a randomized-controlled trial (RCT). PATIENTS We enrolled 98 patients with a history of >4 muscle cramps in the prior month from 7/22-7/23. We randomized patients 1:1 to stretching versus meditation for 35 days. Our primary outcome was the change in cramp severity measured by the visual analogue scale for cramps (VAS-cramps, scaled 0-10). Secondary outcomes included a patient global impression of change (PGIC), change in sleep quality and global HRQOL measured using the EQ-5D and VAS-global HRQOL. RESULTS Overall, 48% of patients had cirrhosis, 40% had diabetes, 16% the median age was 63, most were women (67%) and 81% were college educated. Both arms experienced a reduction in cramp severity-a median of 1.44 (.58-2.29) points for stretching and 1.97 (1.01-2.93) points for meditation. These changes were significant changes from baseline (p = .001 for stretching, p < .0001 for meditation) but these changes were equivalent between arms (p = .4). The PGIC was improved: 1.33 (1.02-1.65) for stretching, 1.05 (.70-1.41) for meditation, p-difference .2. Sleep was also improved for both. HRQOL did not change according to the Eq5D; according to the VAS, HRQOL rose for meditation by 6 (.1-11.8) points but not for stretching. More patients recommended stretching than meditation (79.2% vs. 55.3%, p = .02). CONCLUSION In a randomized trial, stretching and meditation both reduced cramp severity and improved sleep quality and global impression of change. While patients preferred stretching, there was no difference in effect between arms.
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Affiliation(s)
- Elliot B Tapper
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Hirsh Trivedi
- Division of Gastroenterology, Cedars Sinai, Los Angeles, California, USA
| | - Douglas A Simonetto
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, New York, USA
| | - Vilas Patwardhan
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Erin Ospina
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Beanna Martinez
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Xi Chen
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan Walker
- Holistic Integrated Massage and Meditation, Poland, Ohio, USA
| | - Samantha Nikirk
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
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Elafros MA, Seth A. Recognizing Myopathy in Patients with Muscle Weakness or Pain. Prim Care 2024; 51:311-326. [PMID: 38692777 DOI: 10.1016/j.pop.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Muscle weakness and pain can be seen in orthopedic, rheumatologic, cardiac, and musculoskeletal conditions in addition to neurologic disorders. Myopathy, which describes a heterogenous group of hereditary and acquired disorders that affect muscle channels, structure, and metabolism, is one possible cause. This review focuses on essential information to support primary care providers as they assess patients with muscle weakness and pain for myopathy. As with most neurologic disorders, a thorough clinical history and physical examination are essential first steps. These findings will then guide diagnostic testing and facilitate appropriate management or referral for further neuromuscular care.
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Affiliation(s)
- Melissa A Elafros
- Department of Neurology, University of Michigan, 5015 AAT-BSRB, 109 Zina Pitcher Place, Ann Arbor, MI 48109, USA.
| | - Arjun Seth
- Department of Neurology, Northwestern University, 710 North Lake Shore Drive, Abbott Hall, 11th floor, Office #1112, Chicago, IL 60611, USA
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Khandalavala B, Geske J, Klein J. Patient-Reported Prevalence, Characteristics, and Impact of Leg Cramps in an Urban Primary Care Clinic. Ann Fam Med 2023; 21:440-443. [PMID: 37748902 PMCID: PMC10519757 DOI: 10.1370/afm.3013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/08/2023] [Accepted: 04/12/2023] [Indexed: 09/27/2023] Open
Abstract
This study addresses the prevalence and characteristics of leg cramps in 294 primary care patients (mean age = 46.5 years), with 51.7% reporting leg cramps. Patients who experience resting or exercise-induced leg cramps were more likely to be older and female. Cramp severity averaged 5.6 on a scale of 1-10 and disturbed sleep "sometimes" or "often" in 55% of patients. Most patients did not discuss cramps with their clinician. Our study reveals a possible shift in patients who experience leg cramps to younger age and chronicity. Resting leg cramps should be reviewed by clinicians as a symptom of declining health and advancing aging.
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Affiliation(s)
- Birgit Khandalavala
- University of Nebraska Medical Center, Omaha, Nebraska
- University of Nebraska College of Medicine, Omaha, Nebraska
- University of Nebraska Department of Family Medicine, Omaha, Nebraska
| | - Jenenne Geske
- University of Nebraska Medical Center, Omaha, Nebraska
- University of Nebraska College of Medicine, Omaha, Nebraska
- University of Nebraska Department of Family Medicine, Omaha, Nebraska
| | - Jacob Klein
- University of Nebraska Medical Center, Omaha, Nebraska
- University of Nebraska College of Medicine, Omaha, Nebraska
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4
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Kanda T, Sasaki-Tanaka R, Matsumoto N, Arima S, Kanezawa S, Honda M, Totsuka M, Ishii T, Masuzaki R, Ogawa M, Yamagami H, Kogure H. Muscle Cramps in Outpatients with Liver Diseases in Tokyo, Japan. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1506. [PMID: 37763625 PMCID: PMC10532783 DOI: 10.3390/medicina59091506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Muscle cramps are often observed in patients with liver diseases, especially advanced liver fibrosis. The exact prevalence of muscle cramps in outpatients with liver diseases in Japan is unknown. Patients and Methods: This study examined the prevalence of, and therapies for, muscle cramps in outpatients with liver diseases in Tokyo, Japan. A total of 238 outpatients with liver diseases were retrospectively examined. We investigated whether they had muscle cramps using a visual analog scale (VAS) (from 0, none, to 10, strongest), and also investigated their therapies. Results: Muscle cramps were observed in 34 outpatients with liver diseases (14.3%); their mean VAS score was 5.53. A multivariate analysis demonstrated that older age (equal to or older than 66 years) was the only significant factor as-sociated with muscle cramps. The prevalence of muscle cramps among patients with liver diseases seemed not to be higher. The problem was that only 11 (32.4%) of 34 outpatients received therapy for their muscle cramps. Conclusions: Only age is related to muscle cramps, which is rather weak, and it is possible that this common symptom may not be limited to liver disease patients.
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Affiliation(s)
- Tatsuo Kanda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo 173-8610, Japan; (R.S.-T.); (N.M.); (S.A.); (S.K.); (M.H.); (M.T.); (T.I.); (R.M.); (M.O.); (H.Y.); (H.K.)
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5
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Li Y, Zhu R, Wang L, Tan J. Effect of vitamin K2 in the treatment of nocturnal leg cramps in the older population: Study protocol of a randomized, double-blind, controlled trial. Front Nutr 2023; 10:1119233. [PMID: 36908924 PMCID: PMC9996107 DOI: 10.3389/fnut.2023.1119233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction Nocturnal leg cramps (NLCs) are sudden contractions of the leg muscles, usually in the posterior calf muscles at night, affecting sleep quality. Because the precise pathophysiology of NCLs is unclear, different interventions have been proposed. There is conflicting evidence regarding the efficacy of conventional interventions in preventing cramps. Thus, the present study aims to investigate the effects of vitamin K2 for NLCs in a prospective randomized, double-blind, controlled trial. Methods and analysis This multicenter, randomized, double-blind, placebo-controlled clinical study will enroll older age (≥65-year-old) with two or more documented episodes of NLCs during 2 weeks of screening. Participants will be randomized to receive vitamin K2 or a similar-looking placebo for 8 weeks in a 1:1 ratio. Follow-up visits will be scheduled each week at the beginning of 4-week intervention, then participants will be visited semimonthly. The primary outcome is the difference in the mean number of NLCs per week in the vitamin K2 and placebo arms. The secondary outcomes include the severity and duration of NLCs in the vitamin K2 and placebo arms. Two hundred patients will be needed, for this two-treatment parallel design study, to achieve a probability is 90% that the study will detect a treatment difference at a two-sided 0.04 significance level, if the difference between treatments is 3.6 (difference in means between treatment arms) NLC events. Discussion Nocturnal Leg Cramps (NLCs) are a common musculoskeletal disorder in the general population, but effective and safe interventions have not been established. Our previous study has shown vitamin K2 was effective to reduce the frequency, severity, and duration of dialysis-related muscle cramps with a good safety profile. This randomized controlled trial (RCT) of rigorous methodological design will help to establish the effectiveness of vitamin K2 for the management of NLCs in older population. The findings of this RCT will encourage the studies of vitamin K2 in musculoskeletal disorders. Clinical Trial Registration www.ClinicalTrials.gov, identifier, NCT05547750.
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Affiliation(s)
- Ying Li
- Department of Hematology, Chengdu Third People's Hospital, Chengdu, Sichuan, China.,School of Clinical Medicine, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Rui Zhu
- Department of Hematology, Chengdu Third People's Hospital, Chengdu, Sichuan, China.,School of Clinical Medicine, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Li Wang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jing Tan
- Department of Hematology, Chengdu Third People's Hospital, Chengdu, Sichuan, China
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6
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Handa J, Otani K, Nikaido T, Kikuchi SI, Konno SI. Nocturnal Leg Cramps and Lumbar Spinal Stenosis: A Cross-Sectional Study in the Community. Int J Gen Med 2022; 15:7985-7993. [DOI: 10.2147/ijgm.s383425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
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7
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Sebo P, Haller DM, Kaiser C, Zaim A, Heimer O, Chauveau N, Maisonneuve H. Health-related quality of life associated with nocturnal leg cramps in primary care: a mixed methods study. Fam Pract 2022; 39:85-91. [PMID: 34278417 DOI: 10.1093/fampra/cmab082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although nocturnal leg cramps are common, little research is available about their impact on quality of life. This mixed-methods study explored the impact of nocturnal leg cramps on health-related quality of life (HRQoL). METHODS The study included primary care patients (>50 years) who reported suffering from nocturnal leg cramps (2016-2017). In the quantitative phase, patients completed a questionnaire about their HRQoL (SF-36) and the frequency of their cramps, and we computed the SF-36 scores. Then, we conducted a qualitative study using semi-structured interviews with patients with various levels of HRQol to explore their perception of the impact of cramps on their lives. RESULTS A total of 114 patients (49%) agreed to participate in the quantitative study (mean age: 71, women: 62%) and 15 patients were included in the qualitative study (mean age: 69, women: 67%). The number of cramps in the previous week was low (mean: 1.6 (SD 1.5)). The SF-36 mean physical and mental summary scores were 43 and 50, respectively, and the domain scores were similar to a comparative general population. Whilst some patients reported little interference with their daily lives, others reported a major decrease in their HRQoL. SF-36 scores were not sufficient to describe the cramp-related impairment, as patients from all levels of SF-36 scores reported major impacts of NLC in the interviews. CONCLUSIONS Some patients describe a specific impact of cramps on their lives, regardless of their HRQoL. These patients should be the target of future intervention trials.
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Affiliation(s)
- Paul Sebo
- Primary Care Unit, Faculty of medicine, University of Geneva, Geneva, Switzerland
| | - Dagmar M Haller
- Primary Care Unit, Faculty of medicine, University of Geneva, Geneva, Switzerland.,Department of Community, Primary Care and Emergency Medicine, Geneva, Switzerland.,Department of Paediatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Céline Kaiser
- Primary Care Unit, Faculty of medicine, University of Geneva, Geneva, Switzerland
| | - Armita Zaim
- Primary Care Unit, Faculty of medicine, University of Geneva, Geneva, Switzerland
| | - Olivier Heimer
- Primary Care Unit, Faculty of medicine, University of Geneva, Geneva, Switzerland
| | - Nicolas Chauveau
- Primary Care Unit, Faculty of medicine, University of Geneva, Geneva, Switzerland
| | - Hubert Maisonneuve
- Primary Care Unit, Faculty of medicine, University of Geneva, Geneva, Switzerland
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8
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Hawke F, McKay MJ, Baldwin JN, Chiu S, Sadler S, Oldmeadow C, Chuter V, Burns J. Correlates of night-time and exercise-associated lower limb cramps in healthy adults. Muscle Nerve 2021; 64:301-308. [PMID: 34185321 DOI: 10.1002/mus.27359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 06/15/2021] [Accepted: 06/19/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION/AIMS We explored correlates of night-time and exercise-associated lower limb cramps in participants of the 1000 Norms Project. METHODS A volunteer community sample of healthy people aged ≥18 y underwent assessment of motor function and physical performance, and were questioned about muscle cramps in the previous 3 mo. RESULTS Of 491 (221 female) participants age 18-101 y (mean: 59.12; SD: 18.03), about 1 in 3 experienced night-time lower limb cramps, and about 1 in 4 experienced exercise-associated lower limb cramps. For night-cramps, a one unit increase in Beighton score (greater whole-body flexibility) was associated with a 31% reduced odds of cramps (odds ratio [OR] = 0.69, 95% confidence interval [CI]:0.45, 0.99) and passing all three lesser-toe strength tests was associated with 50% reduced odds of cramps (OR = 0.50, 95% CI: 0.32, 0.78). For exercise-associated cramps, participants in the fourth (lowest arch) quartile of Foot Posture Index were 2.1 times (95% CI: 1.11, 3.95) more likely to experience cramps than participants in the first (highest arch) quartile. Odds of experiencing both types of cramps versus no cramps were lower with passing all three lesser-toe strength tests (OR = 0.40, 95% CI: 0.19, 0.85) and better performance in the six-minute walk test (OR = 0.997, 95% CI: 0.996, 0.998). DISCUSSION People who experienced both exercise-associated and night-time cramps were less functional. The association between night-time cramps with less whole-body flexibility and reduced lesser-toe flexor strength should be explored to determine causation. Planovalgus (low-arched) foot type was independently associated with exercise-associated cramps. The effectiveness of foot orthoses for secondary prevention of exercise-associated cramps in people with low-arched feet should be explored.
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Affiliation(s)
- Fiona Hawke
- School of Health Sciences, College of Health, Medicine and Wellbeing, and Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Marnee J McKay
- Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer N Baldwin
- School of Health Sciences, College of Health, Medicine and Wellbeing, and Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, New South Wales, Australia.,Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Simon Chiu
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Sean Sadler
- School of Health Sciences, College of Health, Medicine and Wellbeing, and Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, New South Wales, Australia
| | | | - Vivienne Chuter
- School of Health Sciences, College of Health, Medicine and Wellbeing, and Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Joshua Burns
- Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.,The University of Sydney & The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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9
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Pilot testing a stretching regimen for prevention of night time nocturnal leg cramps. Geriatr Nurs 2020; 41:105-109. [DOI: 10.1016/j.gerinurse.2019.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/13/2019] [Accepted: 07/26/2019] [Indexed: 11/24/2022]
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10
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Delacour C, Chambe J, Lefebvre F, Bodot C, Bigerel E, Epifani L, Granda C, Haller DM, Maisonneuve H. Association between physical activity and Nocturnal Leg Cramps in patients over 60 years old: a case-control study. Sci Rep 2020; 10:2638. [PMID: 32060316 PMCID: PMC7021766 DOI: 10.1038/s41598-020-59312-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 01/24/2020] [Indexed: 11/09/2022] Open
Abstract
Nocturnal Legs Cramps are a frequent disorder, which have a negative impact on quality of life, particularly among patients over 60 years old. Lifestyle factors such as alcohol consumption have been shown to be associated with Nocturnal Leg Cramps. This study aimed to explore the association between nocturnal leg cramps and a sedentary lifestyle among elderly patients. A case-control study was conducted with a Bayesian approach for sensitivity analysis. Patients over 60 years old consulting their family doctor were recruited in the Alsace region, France. Cases were matched with controls free from cramps for age, sex, medical history and medications known to trigger cramps. The level of physical activity was assessed using the Dijon Physical Activity Score (DPAS). We performed univariate and multivariate analyses adjusting for alcohol consumption. 272 participants were matched into 136 pairs. 11% of all were sedentary persons. Adjusting for alcohol consumption, we observed an association between Nocturnal Leg Cramps and a sedentary lifestyle OR = 9.84 (95% credibility interval [1.74; 101.9]; posterior probability 99.68%). Our findings represent an additional argument to promote physical activity to patients over 60 years old. They also highlight the need to develop and evaluate physical activity interventions in the treatment of Nocturnal Legs Cramps.
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Affiliation(s)
- Chloé Delacour
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, 67000, France.
| | - Juliette Chambe
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, 67000, France
| | - François Lefebvre
- Public Health Department, Faculty of Medicine, University of Strasbourg, Strasbourg, 67000, France
| | - Claire Bodot
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, 67000, France
| | - Elodie Bigerel
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, 67000, France
| | - Laetitia Epifani
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, 67000, France
| | - Céline Granda
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, 67000, France
| | - Dagmar M Haller
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, 1211, Switzerland
| | - Hubert Maisonneuve
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, 67000, France.,Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, 1211, Switzerland
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11
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Delacour C, Chambe J, Lefebvre F, Bodot C, Bigerel E, Epifani L, Granda C, Haller DM, Maisonneuve H. Association Between Alcohol Consumption and Nocturnal Leg Cramps in Patients Over 60 Years Old: A Case-Control Study. Ann Fam Med 2018; 16:296-301. [PMID: 29987076 PMCID: PMC6037509 DOI: 10.1370/afm.2238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 12/21/2017] [Accepted: 03/06/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Nocturnal leg cramps are a specific kind of cramps affecting almost one-half of patients aged 60 years and older. They reduce patients' quality of sleep and have a negative impact on their quality of life. The aim of this study was to evaluate the association between nocturnal leg cramps and the consumption of alcoholic beverages in patients aged 60 years and older attending general practices. METHODS Case-control study with a Bayesian approach for sensitivity analysis. Participants were voluntary ambulatory patients aged 60 years and older consulting their family doctor. They were recruited in 67 general practices across the Alsace region. Cases (patients having cramps), were matched with controls (patients free from cramps) for age, sex, medical history, and medications known to trigger cramps. Alcohol consumption was assessed through a standardized food frequency questionnaire. RESULTS We found an association between the global consumption of alcoholic beverages and nocturnal leg cramps (OR = 6.5, 95% credibility interval, 1.68-38.05; posterior probability 99.82%). CONCLUSION We identified an association between alcohol consumption and nocturnal leg cramps among patients aged 60 years and older attending general practices. These findings have implications for the prevention of cramps.
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Affiliation(s)
- Chloé Delacour
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Juliette Chambe
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - François Lefebvre
- Public Health Department, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Claire Bodot
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Elodie Bigerel
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Laetitia Epifani
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Céline Granda
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Dagmar M Haller
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Hubert Maisonneuve
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, France.,Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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12
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Lorenzo M, Schaeffer M, Haller DM, Maisonneuve H. Treatment of nocturnal leg cramps by primary care patients over the age of 60. Fam Pract 2018; 35:29-33. [PMID: 28985304 DOI: 10.1093/fampra/cmx062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Approximately one out of two individuals over the age of 60 suffers from nocturnal leg cramps. These often have an important impact on the person's quality of life. Different drug and non-drug treatments are proposed to treat these cramps, but none to date have been shown to be both safe and effective. The objective of this study was to describe the drug and non-drug treatments used by primary care patients suffering from cramps. METHODS We used data collected as part of two cross-sectional surveys of patients aged 60 years and older attending general practices in the French region of Alsace. We asked the participants suffering from cramps if they were currently using a treatment for their cramps. We distinguished potentially harmful from unharmful treatments. RESULTS Overall, 632 patients suffering from cramps were included in our study. Only 133 patients (19.5%) were taking a treatment for cramps. 82 patients used one or several of 17 different drug treatments. 58 patients used one or several of 13 different types of non-drug treatments. Potentially harmful treatments, mostly Quinine made up 16,7% (n = 25) of all treatments used for cramps. CONCLUSIONS This study sheds light on the great diversity of therapeutic practices for cramps in outpatient care. Many of the treatments reported by patients have not previously been described in the medical literature. We recommend GPs to ask their patients about the treatments they take for cramps in order to make sure that they are safe.
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Affiliation(s)
- Mathieu Lorenzo
- Department of General Practice, Faculty of Medicine, University of Strasbourg, Strasbourg, France - Clinical Investigation Unit INSERM - CIC 1434, Strasbourg, France
| | - Mickaël Schaeffer
- Public Health Department, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Dagmar M Haller
- Primary care unit, University of Geneva, Geneva, Switzerland
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13
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Weiker MK, Nielsen B, Waclawik AJ, Staples AC, Hansen KE. Muscle Cramps Do Not Improve With Correction of Vitamin D Insufficiency. WMJ : OFFICIAL PUBLICATION OF THE STATE MEDICAL SOCIETY OF WISCONSIN 2017; 116:200-204. [PMID: 29357208 PMCID: PMC6324187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Minimal treatment options exist for idiopathic muscle cramps. OBJECTIVE We evaluated whether correction of vitamin D insufficiency relieved muscle cramps in postmenopausal women. METHODS We conducted a post hoc analysis of a randomized, double-blind, placebo-controlled trial at a single academic medical center in the Midwest to evaluate the benefits of treating vitamin D insufficiency. Two hundred thirty postmenopausal women participated. Eligible women were ≤75 years old, 5 years past menopause or oophorectomy, or ≥60 years if they had previously undergone hysterectomy without oophorectomy. Women had vitamin D insufficiency at baseline (25-hydroxyvitamin D 14-27 ng/mL). We excluded subjects with a glomerular filtration rate <45 mL/minute. INTERVENTIONS FOR CLINICAL TRIALS Participants completed food diaries, laboratory studies, and functional tests including the Timed Up and Go test, Physical Activity Scale for the Elderly, Health Assessment Questionnaire (a measure of disability), and pain scores. Subjects recorded muscle cramp frequency and severity using a standardized form at 6 visits over 1 year. RESULTS During the trial, over half of participants (n=121, 53%) reported muscle cramps. Despite unequivocal vitamin D repletion, vitamin D had no effect on muscle cramps. Pain levels, disability, and dietary potassium predicted presence of cramps. Serum albumin and physical activity were inversely associated with, and disability was positively associated with, severity of muscle cramps. CONCLUSIONS Further studies are needed to evaluate the link between pain, disability, dietary potassium intake, and muscle cramps.
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Affiliation(s)
- Madelyn K Weiker
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Birgitte Nielsen
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Andrew J Waclawik
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Abigail C Staples
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Karen E Hansen
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin,
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Roguin Maor N, Alperin M, Shturman E, Khairaldeen H, Friedman M, Karkabi K, Milman U. Effect of Magnesium Oxide Supplementation on Nocturnal Leg Cramps: A Randomized Clinical Trial. JAMA Intern Med 2017; 177:617-623. [PMID: 28241153 PMCID: PMC5818780 DOI: 10.1001/jamainternmed.2016.9261] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Magnesium supplements are widely marketed for prophylaxis of nocturnal leg cramps (NLC) despite no evidence of significant benefit. OBJECTIVE To determine whether magnesium oxide is better than placebo for NLC prophylaxis. DESIGN, SETTING, AND PARTICIPANTS A randomized, double-blind, placebo-controlled clinical trial of 2 weeks eligibility screening followed by 4 weeks of treatment was conducted in northern Israel, from February to October 2013. An intention-to-treat data analysis was performed from March 22, 2014, to April 17, 2016. We used a volunteer sample of community-dwelling individuals experiencing NLC, 21 years or older, with 4 or more documented episodes of NLC during 2 weeks of screening. INTERVENTIONS Capsules containing either magnesium oxide or a similar-looking placebo to be taken orally, once daily at bedtime for a period of 4 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was the difference in the mean number of NLC per week between the screening and treatment phases. Secondary outcomes included severity and duration of NLC, quality of life, and quality of sleep. RESULTS Of the 166 volunteers, 72 (43%) were excluded, of whom 15 declined to participate and 57 did not meet the inclusion criteria. Of the 94 individuals (39% male; mean [SD] age, 64.9 [11.1] years) randomly assigned to magnesium oxide (48) or placebo (46), 6 did not complete the study protocol (3 in each group). Mean (SD) change of NLC was -3.41 (4.05) (from 7.84 [5.68] to 4.44 [5.66]) and -3.03 (4.53) (from 8.51 [5.20] to 5.48 [4.93]) per week in the magnesium oxide and placebo groups, respectively, a difference between groups of 0.38 (0.48) NLC per week (P = .67 in an intention-to-treat analysis). There were no between-group differences in the severity and duration of NLC, quality of life, or quality of sleep. CONCLUSIONS AND RELEVANCE Oral magnesium oxide was not superior to placebo for older adults experiencing NLC. The decrease in the mean number of NLC per week, from the screening to the treatment phase in both groups, is probably a placebo effect that may explain the wide use of magnesium for NLC. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01709968.
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Affiliation(s)
- Noga Roguin Maor
- Clinical Research Unit, Clalit Health Services, Haifa and Western Galilee District, Israel2Department of Family Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Mordechai Alperin
- Clinical Research Unit, Clalit Health Services, Haifa and Western Galilee District, Israel2Department of Family Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Elena Shturman
- Clinical Research Unit, Clalit Health Services, Haifa and Western Galilee District, Israel2Department of Family Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hassan Khairaldeen
- Clinical Research Unit, Clalit Health Services, Haifa and Western Galilee District, Israel2Department of Family Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Moran Friedman
- Clinical Research Unit, Clalit Health Services, Haifa and Western Galilee District, Israel2Department of Family Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Khaled Karkabi
- Clinical Research Unit, Clalit Health Services, Haifa and Western Galilee District, Israel2Department of Family Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Uzi Milman
- Clinical Research Unit, Clalit Health Services, Haifa and Western Galilee District, Israel2Department of Family Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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