Compounded Treatments Relieve the Lingering Pain and Soreness of Nocturnal Muscle Cramps
Everyone experiences the occasional muscle cramp, so they know all about the excruciating pain—but understand the discomfort is short-lived. While it’s true that most muscle cramps only last a few minutes, nocturnal muscle cramps can be long lasting and cause lingering soreness for days. Beyond the sleep-disturbing pain, these nighttime cramps may lead to chronic insomnia and mental distress. Compounded treatments can offer relief from the ongoing discomfort, but suffering patients may not realize they have options unless compounding pharmacists reach out.
Nocturnal muscle cramps primarily occur in the posterior calf muscle, but can also involve foot muscles where extreme flexion makes it impossible to walk. The only medication proven to help nocturnal cramps—quinine—has the potential to cause serious hematologic abnormalities and other less common side effects such as hypoglycemia, liver toxicity, and cardiac arrhythmias. Guidelines issued by the American Academy of Neurology recommend prescribing quinine only when nighttime muscle cramps are disabling and other treatments have failed.1
Other treatment choices are limited. Vitamin B complex and diltiazem are rated as possibly effective for nocturnal muscle cramps. Some patients find relief from carisoprodol, gabapentin, and verapamil, but their efficacy needs to be verified with more research. Finally, limited evidence suggests that magnesium supplements and calcium channel blockers may treat nocturnal muscle cramps.2
Patients with severe and persistent nocturnal muscle cramps should be encouraged to get a complete medical workup because an underlying disorder could be the cause. Peripheral vascular disease, low potassium, coronary artery disease, cirrhosis, neuropathy, endocrine disorders, and Parkinson’s disease all may lead to nighttime cramps. Medications are rarely the problem, but should still be ruled out as some can trigger cramping.
Compounding Options to Relieve Pain, Relax Muscles, and Enhance Sleep
Considering the lack of safe and effective medications, the only options are topical treatments that relieve lingering pain and relax muscles after the cramp abates. You won’t find topicals included in most treatment protocols for nocturnal cramps, which means that compounding pharmacists should reach out and let patients know what’s available. The first step is taking the time to assess their cramps:
- Ask about frequency, duration, and lingering effects of nocturnal cramps.
- Assess potential underlying conditions and perform a medication review to rule out these causes.
- Ask if patients have insomnia, depression, or anxiety due to the cramps.
- Refer them to a physician if the cramps are debilitating, you find underlying causes, the patient has trouble functioning during the day, or they develop muscle weakness.
Once you have a good assessment, discuss the benefits of compounding. Many patients don’t know that topical treatments penetrate to muscles without causing systemic side effects.3 Also emphasize that treatments can target their symptoms by combining a variety of pharmaceutical and natural ingredients. Some patients may benefit from baclofen mixed with a topical NSAID such as ketoprofen or diclofenac, while others might only need natural pain relief from menthol. Ask about insomnia, whether they need help relaxing, and the presence of anxiety or depression, which opens the door to compounding natural products such as melatonin, SAMe, and St. John’s Wort.
Challenge of Identifying Patients
The challenge for compounding pharmacists is identifying potential patients. The most obvious way is to ask people buying OTC products for muscle cramp relief if they have nighttime cramps, then suggest they talk with the pharmacist about tailor-made treatments. A second outreach tactic is to put up a poster that calls attention to nighttime muscle cramps and suggests the pharmacist can help. Finally, you may be able to reach out to patients by tracking the type of prescriptions they fill. In addition to the recommended treatments, some physicians prescribe medications used for restless leg syndrome:4
- Dopamine agonists: Medications such as ropinirole, rotigotine, and pramipexole are FDA approved for restless leg syndrome.
- Calcium channel blockers: Gabapentin and pregabalin are used to relieve RLS symptoms.
- Muscle relaxants: RLS patients may take baclofen and other relaxants.
Helping Patients Beyond Medication
Up to 60 percent of adults over the age of 50 experience nocturnal muscle cramps. It’s hard to predict the amount of business this represents, but one thing is certain: patients with chronic nighttime cramps are likely desperate for some relief. The dearth of proven medications creates an opportunity for compounding pharmacists to intervene, offer treatment options, and improve quality of life.
Pharmaceutica North America provides many medications that compounding pharmacists can use to meet the unique needs of patients with nocturnal muscle cramps. Please contact us today to talk about our bulk APIs, custom kits, and OTC supplements.
- “Assessment: Symptomatic Treatment for Muscle Cramps (an Evidence-Based Review). Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology,” February 2010, http://www.guideline.gov/content.aspx?id=15851 ↩
- “Nocturnal Leg Cramps,” August 2012, http://www.aafp.org/afp/2012/0815/p350.html ↩
- “Topical Preparations for Pain Relief: Efficacy and Patient Adherence ,” 2011, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048583/ ↩
- “Restless Leg Syndrome: Treatment and Drugs,” December 2014, http://www.mayoclinic.org/diseases-conditions/restless-legs-syndrome/basics/treatment/con-20031101 ↩