Treating spasms and stiffness
Even if you feel your spasms or stiffness are not major problems for you, it is a good idea to make your doctor or MS nurse aware of the issue so that you can find appropriate ways to manage it and avoid complications later on.
Management might include:
The effects of spasms and stiffness vary widely, so treatment needs to be tailored to your own needs and abilities.
Health care professionals will assess your spasms or stiffness, taking into account the nature of your symptoms, possible trigger factors that make them worse and – very importantly – the impact they have on your daily life.
Your health team might recommend:
- Range of motion exercises – exercises designed to help you keep maximum movement in a joint may reduce muscle stiffness and prevent stiff joints from lack of use.
- Stretching - stretching muscles can also help prevent long-term complications.
- Strengthening - can help prevent weakness in muscles which can make daily activities and moving about more difficult.
- Light pressure or stroking (touching the muscle may calm the message pathways and relax the muscle, allowing you to stretch or move a little further) .
- Complementary therapies or meditation to help you relax.
Your doctor or MS nurse can refer you to a specialist physiotherapist.
While movement, through physiotherapy and exercise, is important in managing stiffness due to MS, they are sometimes not enough on their own.
Drug treatments can often help, especially when used together with physiotherapy. There are many different drugs used in the treatment of spasticity. All drugs have side effects, and your doctor will talk through the pros and cons of using these drugs.
- Baclofen (Lioresal, Lyflex)
- Tizanidine (Zanaflex)
- Gabapentin (Neurontin)
- Dantrolene sodium (Dantrium)
- Diazepam and clonazepam
- Baclofen pump (intrathecal baclofen)
- Liquid phenol (intrathecal phenol)
A muscle relaxant that can reduce the number of spasms and levels of muscle stiffness.
A muscle relaxant can reduce stiffness and spasms and may be particularly useful to treat painful night-time spasms.
Because its effects last for only 3-6 hours, it can be best used around specific times when relief from symptoms is most important, for example at bedtime.
An anticonvulsant drug that calms overactive messages in the central nervous system that might cause spasms.
This drug is not used as commonly as baclofen or tizanidine to treat spasms and stiffness in MS, but it can be a suitable option for some.
Sativex is a cannabis-based drug for treating uncontrolled muscle movements (spasm) and muscle stiffness (together known as ‘spasticity’). Sativex is an oral spray containing ‘cannabinoid’ chemicals taken from cannabis plants. It’s sometimes called nabiximols.
Sativex works on the cannabinoid receptors in the brain and spinal cord. You start off taking one dose a day slowly adding more doses (but no more than 12 a day) until you get the most relief from your symptoms.
Can I get Sativex?
In 2014 the National Institute for Health and Care Excellence (NICE), who recommend which drugs can be available on the NHS, decided Sativex didn’t give people enough benefit to justify the cost. Because of this, Sativex hasn’t been available since then on the NHS in England, Scotland and Northern Ireland. Sativex is available on the NHS in Wales if your spasticity is ‘moderate’ to ‘severe’.
Your MS specialist might be able to help you get this drug by helping you put in an ‘individual funding request’ to your local NHS Trust. These applications may be turned down. If you can pay the cost yourself, a private prescription is around £500 a month. Faced with these barriers some people with MS buy cannabis illegally.
Is Sativex effective?
Around half of the people who took Sativex in one trial found their symptoms were reduced by 20% within four weeks. In those people that Sativex works for there’s a significant improvement in symptoms. If the drug doesn’t have an effect after four weeks treatment is usually stopped.
Although only licensed for muscle spasms and stiffness, some people who use Sativex also say it helps with other MS symptoms such as pain, bladder problems, difficulty sleeping and tremor. A 2014 study found it didn’t help with tremor but was ‘probably effective’ for spasticity, pain and bladder problems.
What are the side-effects?
Side-effects include feeling sick, sleepy, dizzy, tired or having diarrhoea, headaches or a dry mouth. Some people report a feeling similar to the ‘high’ you get from smoking cannabis. Side-effects tend to get less after a few weeks and can be reduced by taking fewer doses. It can cause soreness in the mouth. This can be avoided by changing the part of your mouth you spray on.
Sativex shouldn’t be used if you’re pregnant or breastfeeding, under 18 or have had certain serious mental health problems.
You can still drive if you use Sativex, but not when it’s making you feel sleepy, dizzy, or is affecting your concentration or eyesight. This goes for other dangerous activity like operating machinery.
For some people cannabis causes problems with memory or mental health. Sativex doesn’t have these problems – and you can’t become dependent on it.
This drug works directly on muscles, reducing their ability to contract.
Diazepam is a muscle relaxant that can reduce stiffness and spasms.
Because of side effects at higher doses, it may be more useful at night. Diazepam is no longer widely used to treat MS spasms and stiffness, but can help some people if other treatments have not worked.
Clonazepam is similar but may be particularly effective for night time spasms.
Both drugs are 'benzodiazepines' - a type of drug that can be addictive with long-term use, so should not be taken for too long.
Baclofen is supplied continuously to the fluid around the spinal cord. A pump that is surgically implanted near the waistline controls the dose. This system is known as 'intrathecal' injection.
For those with more severe spasms or stiffness, who do not gain adequate benefit from tablet medications, this can be helpful.
By delivering the drug directly to the area in which it works, it can be more effective. Because of this, doses can be kept lower, keeping side effects to a minimum.
Phenol is injected directly into the fluid around the spinal cord ('intrathecally').
It can be helpful for some people to treat very severe spasms that do not respond to physiotherapy and other drug treatments.
Phenol destroys the nerves that control sensation and movement, so it is only used where a person already has limited control of these parts of their body.
There is a range of equipment which might be helpful - ask a physiotherapist, nurse or occupational therapist if you think the techniques below might benefit you.
- Braces and splints for stretching 'locked' muscles
- Standing frames can stretch the muscles by standing, even if normally this would be difficult or impossible.
- Specially designed beds and chairs can help some people find a suitable posture or by using placing pillows or cushions where needed.
- Correct positioning and support for the body when sitting or lying down can also help you avoid your skin rubbing and causing sores, and prevent aches and pains that can come from poor posture. For more on posture download this factsheet.
Used in combination with drug treatments, some people find electrical stimulation therapies useful. These therapies use electrical impulses to stimulate the muscles and nerve fibres affected by spasticity.
Access to these kinds of therapies varies around the country. Your doctor, physiotherapist or MS nurse can refer you to an appropriate service.
A device that stimulates the muscles and nerve fibres of the ankle and foot, called functional electrical stimulation (often known as FES) can help to combat ‘drop foot’. This is where the muscles can’t smoothly control the foot’s actions during walking.
Read more about accessing FES
This is another form of electrical stimulation that is applied through pads attached to the surface of the skin. TENS machines may help control the pain that some people experience with muscle spasms.
TENS is based on principles similar to those of acupuncture – that stimulation of the nerves can affect the way pain signals get through to the brain, potentially easing the pain that is felt. It may be particularly useful for managing the pain of spasms at night, especially if these spasms disrupt sleep.
Occasionally, orthopaedic surgery and neurosurgery can help restore movement and posture, or can be used to relieve severe, ongoing spasms. See the booklet Muscle spasms and stiffness for more information.