Okay. I know a bit about muscle cramps and RSD, having had them beginning with a sudden onset one night in the Fall of 2001 - a few months into the RSD - when I woke up in the middle of the night and both legs were in such complete spasm they had turned to some form of living but incredibly painful stone.

Forget about the tonic water. It's useless. Xnay on quinine too. (In fact, the FDA has recently banned the use of quinine for muscles cramps. So much for tonic water!) However, among the nutritional supplement, folic acid [800 mcg./day] comes recommenced as does a gram a day of magnesium, as Frogga has pointed out. There may be other supplements that are useful as well.

Following again on Frogga's comments, what I think you really need are one of two drugs that really work in controlling CNS induced muscle spasms, Zanaflex or Baclofen. (This is in contrast, for instance, to Flexeril, which addresses cramping due to local muscles tears and the like, and is not nearly as effective in my experience for RSD related cramping.) I was initially on Baclofen but stopped taking it when I was still working as a lawyer and it was interfering with my short term memory. I went to Zanaflex instead (up to 24 mg./day). That took some getting used to as it made me more than a little sleepy for the first year that I was on it. That went away eventually. Unfortunately, the Zanaflex itself suffered from diminishing returns to scale, so in the last few months, I've gone back to Baclofen, which I'm taking up to 40 mg./day, and that really helps.

(And as for the memory issues, I'm also taking 30 mg./day of Namenda and an working up to 16 mg./day of Razadyne, both of which seem to help as well. But then again, I'm no longer in a position where I can practice law, e.g., bet other folks' money on my memory.)

There is a whole other area to be looked at as well. Recent experimental research has shown that opioids (narcotics) tend to bind to the wall of the intestine, causing not only constipation - which many of us know only too well - but also a "bloom" of bacteria in the small intestine that produces neurotoxins! After this was confirmed with gas spectrometry of my breath - blowing up little mylar balloons over a 3 hour period - I was first treated with a ten day course of an expensive antibiotic which insurance didn't cover - Xifaxan - that set me back a little over $300.00, but instantly resolved the cramping.

Since then, as a prophylactic measure, I do three things to keep my GI system in check. First, I take in pediatric dose of Erythromycin E.E.S. 200 200/5ml [1 ml. in the a.m.] in order to assist peristalsis. Next, every time I take a narcotic analgesic, I wash it down with Naloxone HCL (Narcan) (.4 mg. [1.0 cc]) taken orally in order to specifically block intestinal opioid receptors. For a link to trials of a new but closely related drug currently in phase III clinical trials to address this specific issue, go to http://www.pubmed.gov and run a search for "Methylnaltrexone: MNTX." Having said this, please note that Narcan is usually given IV or IM and is a gnarly drug, used to - violently - pull someone out of an OD situation. However, given orally, it's been entirely benign in my experience, except - for those who care - it also seems to block the "high" of the narcotic experience, while allowing the analgesic effect to go on unimpaired. See, also, Vickers AP, Jolly A. "Naltrexone and problems in pain management," BMJ, 2006 Jan 21;332(7534):132-3; free full text at: http://www.bmj.com/cgi/content/full/332/7534/132.

Finally, I just take 2 tablets a day of Senna-S, which is a good natural vegetable laxative/stool softener, and that, coupled with everything else, seems to address both the obvious GI issues related to the use of opioids and the more insidious neuro-toxicological issues as well.

I hope this is useful. In any event, I've spent years working with this, and it's the best I've been able to come up with.

Mike