I've been getting these again. They awaken me from sleep, and last a half hour or more, resistent to anything I try: massaging, stretching, walking. It seems any movement I make in my legs during sleep, the legs cramp in that direction. So if I've got a cramp that is pulling my ankle in, typically, you'd stretch it out to stop it, but that just gives me a cramp in that direction. I walk, and then my toes cramp. And then I awake in the morning exhausted.

Last I wrote about it I had not taken extra magnesium, and at the suggestion of folk here I did. It maybe decreased the number of cramps a bit. Not much. I stopped it and the cramps disappeared for a good couple of weeks. Now back with a vengeance.

This is what I've found: (Both quinine and Magnesium are similarly helpful, but don't do a whole lot; quinine has possible serious side effects; trigger point injection if there are trigger points in the calf muscles are as good as quinine.)

I have to say, if I had 8 cramps in 4 weeks, as these patients have, I wouldn't be complaining. I'm talking 2 - 3/night.

This first study shows magnesium wasn't significantly better than placebo, but there was a "trend".

Med Sci Monit. 2002 May;8(5):CR326-30.

Randomised, cross-over, placebo controlled trial of magnesium citrate in the treatment of chronic persistent leg cramps.

Roffe C, Sills S, Crome P, Jones P.

Department of Geriatric Medicine, Keele University, Staffordshire, UK. christine.roffe@nsch-tr.wmids.nhs.uk

BACKGROUND: Nocturnal leg cramps are common and distressing. The only treatment of proven effectiveness is quinine, but this has a number of side effects. Magnesium salts have been shown to reduce leg cramp distress in pregnancy. This study tests whether magnesium citrate is effective in the treatment of leg cramps in non-pregnant individuals by conducting in a randomised, double-blind, cross-over placebo-controlled trial.

MATERIAL/METHODS: Volunteers suffering regular leg cramps were recruited. Magnesium citrate equivalent to 300 mg magnesium and matching placebo were given for 6 weeks each. The number of cramps recorded in the cramp diary during the final 4 weeks of magnesium and placebo treatment, severity and duration of cramps and the participants' subjective assessment of effectiveness were analysed.

RESULTS: In subjects who started with placebo (29) the median number of cramps was 9 on placebo and 5 on magnesium. For the group starting with magnesium (17) the median no of cramps was 9 ) on magnesium and 8 on placebo. There was no significant carry-over effect (p=0.88), but a highly significant period effect (p=0.008). There was a trend towards less cramps on magnesium (p=0.07). There was no difference in cramp severity and duration between the groups. Significantly more subjects thought that the treatment had helped after magnesium than after placebo 36 (78%) and 25 (54%) respectively, (p=0.03). Diarrhoea was recorded as a side effect of magnesium.

CONCLUSIONS: The results suggest that magnesium may be effective in treatment of nocturnal leg cramps. Further evaluation is recommended.

PMID: 12011773 [PubMed - indexed for MEDLINE]

In this one, there was response to quinine, with a 50% reduction in cramps, but the doctors were more impressed with this than were the patients.



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Int J Clin Pract. 2002 May;56(4):243-6.Links

Effectiveness of quinine in treating muscle cramps: a double-blind, placebo-controlled, parallel-group, multicentre trial.

Diener HC, Dethlefsen U, Dethlefsen-Gruber S, Verbeek P.

Department of Neurology, University of Essen, Germany.

To determine the efficacy and safety of quinine in treating nocturnal muscle cramps we performed a double-blind, placebo-controlled, parallel-group, multicentre trial in 17 general practice centres in Germany. Ninety-eight patients aged 18-70 years with more than six muscle cramps in two weeks were enrolled. A two-week run-in period without treatment was followed by two weeks of treatment with 400 mg quinine or placebo per day and a wash-out period of two weeks without treatment. The primary outcome measure was the reduction in the number of muscle cramps between the run-in and treatment periods. The intensity of cramps, number of nights with cramps, sleep disturbance and intensity of pain were recorded as secondary outcome measures. At baseline the median number of cramps was 12 in two weeks in both groups. The median reduction between the run-in and therapy phases was eight (95% CI 7-10) versus six (95% CI 3-7) muscle cramps during quinine and placebo treatment; 36 (80%) participants in the quinine group and 26 (53%) in the placebo group had a reduction of at least 50% in the number of muscle cramps. Frequency, intensity and pain at night showed a statistically significant difference in favour of quinine. The improvement was more evident according to physician assessment than patient assessment; this is corroborated by the high placebo response rate. No significant differences were found between the two groups with respect to side-effects. Short term treatment with 400 mg quinine per day can effectively prevent nocturnal leg cramps in adults without relevant side-effects.

This looked the most interesting: trigger point injection where there are trigger points.

PMID: 12074203 [PubMed - indexed for MEDLINE]

J Med Assoc Thai. 1999 May;82(5):451-9.Links

The relationship between myofascial trigger points of gastrocnemius muscle and nocturnal calf cramps.

Prateepavanich P, Kupniratsaikul V, Charoensak T.

Department of Physical Medicine and Rehabilitation, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

To support that myofascial pain syndrome (MPS) of gastrocnemius muscle is one cause of nocturnal calf cramps, quantitative assessment of the efficacy of trigger point (TrP) injection compared with oral quinine in the treatment of nocturnal calf cramps (NCC) associated with MPS of gastrocnemius muscle was designed. Twenty four subjects with NCC and gastrocnemius TrPs were randomly divided into two groups of twelve for each treatment. Patients in group 1 were treated with xylocaine injection at the gastrocnemius TrP, and 300 mg of quinine sulfate p.o. was prescribed for patients of group 2. The treatment period was four weeks with a follow-up 4 weeks later. Cramps were assessed quantitatively (in terms of frequency, duration, pain intensity, cramp index, and pain threshold of the gastrocnemius TrPs) before treatment, after treatment and at the end of the follow-up respectively. The outcome of treatment in both groups showed a statistically significant reduction in all quantitative aspects of cramps (95% confidence interval). Also the pain threshold of the gastrocnemius TrP was significantly increased in group 1 only when comparing the pre-treatment and at the end of follow-up. In comparing the two groups we found no statistical difference during the period of treatment. The benefit of both strategies lasted up to four weeks following cessation of the treatment but the outcome of all measures (except pain threshold) were found to be significantly better in the group treated with TrP injection. The results of this study support that gastrocnemius trigger point is one cause of NCC and show that the TrP injection strategy for NCC associated with myofascial pain is not only as effective as oral quinine during the treatment period but also better in the prolonged effect at follow-up.

PMID: 10443094 [PubMed - indexed for MEDLINE]