Spasticity and Its Treatments
The National Multiple Sclerosis Society reports that approximately 80 percent of MS patients experience muscle spasticity. Spasticity is experienced as muscle stiffness in the legs, arms, back, buttocks, and groin, with or without pain. It can also manifest as a spasm, where muscles “jump” in a sometimes visible pulsing or rippling pattern, with or without pain.
Never have we had so many treatment options for muscle spasticity as we have today. But as plentiful as the options may be, many of us still struggle to manage our stiffness, painful cramps and spasms despite using one or more of those treatment methods. Let’s look at the options available in the US and the difficulties we might face when using them.
Treatment options for muscle spasticity
Prescription muscle relaxants. Some treatments are long-established, inexpensive oral generic drugs such as baclofen, diazepam, dantrolene, and tizanidine. Rxlist.com lists these side effects some people might experience:
- Low blood pressure
- Respiratory depression
- Trouble sleeping
- Increased urinary frequency or urinary retention
Most people who take these drugs long-term either do not experience those symptoms or have some to a mild degree.
Though these drugs are generally well-tolerated, the body can build up a resistance and need a higher and higher dose over time. Multiple sclerosis patients’ spasticity can also worsen over time, requiring an increased dose to keep up with the stiffness and cramping.
Baclofen, one the most popular and effective muscle relaxants, also comes in liquid form and can be delivered directly into the spinal fluid via an intrathecal baclofen pump implanted in the patient’s abdomen. This delivery system bypasses the digestive system and blood stream, thereby requiring a much smaller dose of medicine and delivering it directly to its intended target without causing drowsiness and other side effects of the oral version.
Stretching, exercise, and massage
Medical professionals agree that stretching is a necessary part of treating muscle stiffness. According to Dr. Ken Seaman, PT, MA, DPT, daily stretching maintains range of motion, something that can be lost over time and eventually become irreversible without surgical intervention. The main problem with this treatment is that movement can be difficult and painful for the patient and cause them to avoid it all together. Stretching might cause rebound pain and stiffness. A physical therapist would start the patient on an individualized program that should be continued at home. But PT co-insurance can be expensive and the patient might lack motivation to keep doing it without supervision. Aquatherapy is very effective, but requires paying a membership fee at a fitness center and self-motivation to keep showing up at the pool. Exercise may result in injury if it isn’t preceded by stretching. If the patient can tolerate massage it could be very effective in releasing stiff muscles and relieving pain, but it’s expensive and usually not covered by insurance.
The Food and Drug Administration (FDA) has approved some cannabis-like products to treat pain such as Marinol and Syndros—two oral sprays that use a synthetic form of THC—but not all insurance companies will cover them (including my Medicare Part D drug plan administered by United Health Care). Sativex, a cannabis-based oral tincture derived from Sativa and Indica species, is approved abroad but not in the United States. The FDA steadfastly keeps cannabis a Schedule I substance as defined by the United States Controlled Substances Act as:
- Having a high potential for abuse
- Has no currently accepted medical use in treatment in the United States
- There is a lack of accepted safety for use of the drug or other substance under medical supervision
Advocates are fighting for federal legalization of medical cannabis, but so far it’s being left up to the states. Clinical study results have been mixed in an effort to prove whether cannabis safely decreases pain and spasticity. Though many MS patients who smoke marijuana swear by its pain-relieving properties, negative effects on cognitive function remains a legitimate concern. Tetrahydro cannabinol (THC) is the property that produces a euphoric high—and is responsible for compromising cognitive function. But products using cannabidiol (CBD) with a low THC content may not be as effective in relieving pain and spasticity. Some studies suggest the best outcome is achieved when all properties are present in the product. Amid these conflicting reports, the status of this Schedule I substance might not change for some time to come.
Despite the challenges, most people find a combination of spasticity treatments that suit the degree to which it affects their daily lives. It is generally easier to manage spasticity in the earlier stages of MS and then becomes more challenging with disease progression. Mild spasticity that once responded well to daily yoga might advance well beyond the limitations of stretching and require medication, massage, exercise, and any combination of approaches. The only way to know which methods work best for you is to try them out, report the results to your neurologist, and tweak it according to your needs. Other than fatigue, spasticity is one of the most troubling symptoms and can, over time, restrict your body’s ability to move safely and predictably.
For more information about treatment options, see the reference section below.
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