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]

Liza Jane,

This is one of my main symptoms of PN, but my neuro prescribed Baclofen and it does help. It is a short acting muscle relaxer (6 - 8 hours) that I take at bedtime. I usually wake up with a leg cramp when I first move my legs and have to get up and stretch it out, but they don't usually wake me up now. Sometimes I get them during the day (but only when I haven't been moving them and then suddenly do) so at times, I take the Baclofen during the day. If the cramping is particularly bad, my muscles can be very sore and stiff and the Baclofen seems to help. The stiffness can go on for several weeks after any particular bad cramp.

My doc also prescribes Klonopin (a benzo), but I can't take that because of it's addictive qualities...I am a sober alcoholic.....

Best of luck to you...I found that the magnesium route didn't really make a dent in my cramps..

Ann

I get them too. Always have since my Pn. Sometimes they can be very bad. Magnesium helps me but modestly. Last week I woke up in middle of night with cramps in both calves. It felt like my legs were broken it hurt so much. For 3-4 days afterwards both calves were really sore.

The only thing that works for me short of taking a pill is doing leg stretches at least twice a day.

I wonder if the muscle is so tight and cramppy because it's shortening due to PN?

Anyways I don't know the answer LJ, but I can empathise.

Calcium is a player in leg cramps. Too much or too little, will trigger them.

So what is new? What drugs are you taking that are new?

What supplements have you done/changed? Think back to before severe cramps and after.

Use of a calcium channel blocker will set off cramps for example.

Low iron?

Try putting 1/2 of a lidoderm patch behind your knee at bedtime. Just above the bend at the hamstring level. You have these? This sometimes helps too.

Did you change your thyroid hormone?

Are they equal on both legs? (this tends to suggest a systemic issue)
If not , this suggests a irritated nerve on one side.

I used to keep a heating pad plugged in on my side of the bed. When I was working midnights I'd get them every day... and the heating pad helped.
(those were the days BEFORE supplements, and magnesium tho).

The 3 basic things that come to mind are Potassium, Magnesium and Calcium.
They have to be balanced. If you are taking Vit D in high doses, you can reduce your calcium supplement intake.

I think Quinine is useless (and dangerous).

my mother,husband and i were all told many years ago we had restless leg
sysntrone...at times quinine was giving at bed time,it would be precribled by
prescription and another times the pharmacist was aloowed to give it out without prescriction..,i believe it helped with the calve pains.
but after many tests mama,my husband and little old me wewe ended up with
pn. bob was told it was restless leg. mama and my husband have passed
away but both continued complaining..neuorotin 3600 mg stopped mine,
until resently,streching and massage in kneeding fashion helps,but it's awful
i hate it it's very painful,not to mention lack of sleep. bob has no problem
at the moment..it does bring out the tears,i felt the quinine,helped..but my
hands and arms are doing the same thing..sorry for poor writing took a flyer
down the steps ,broke lelt wrist think i have concussion as well. i hope it
goes away the pain is alful in the calves and both ankles fall to left if on back.
i feel sorry for anyone going through this..i had hoped this left me but darn it's back,i must have more tests in st louis...hugs to all,i am also going to beg
to be put back in rehab for a month..sue

bob gets a itching problem with ledoderm patch..it really helped me just
the way you said the other day,my gp agreed to it. and my 92 year old
aunt ues it for her knee,her dr. is thrilled,she is not hurting. my neouro
would not concisder quinine she insists it is dangerous but can't remember
why sorry. sue

Are you drinking enough water? dehydration will result in muscle cramping. If this is the case some pedialyte and drinking water more often would help.

Thanks for all the ideas and questions. I'll try to reply more specifically.

I got leg cramps for the first time last summer, when I was on Forteo, which elevated my serum Calcium. When I stopped the drug, the cramps stopped.

They returned about two months ago with a vengeance, and I posted and began taking Mg, with modest results.

Lab tests done at some point were normal, but I'm not sure they've all been checked recently.

I've been hypothyroid for a few months now. Two weeks ago I pulled an article that said that lipoic acid lowers thyroid levels. My endocrine lowered my Synthroid and increased my cytomel and I stopped the lipoic acid.

I do think I get dehydrated; that is true. I don't drink enough.

My iron hasn't been checked in a while.

Also, I am on a LOT of antibiotics. Orally, I am on Biaxin, Ceftin, Diflucan, and Septra. That's been about 2 weeks. (In addition there are two antibiotics that I irrigate with--premade and sterile, Mrs D)

The cramps came back about 3 or 4 days ago. They are really bad, because when I stretch one out, the secodn movement cramps. In fact, any movement will cramp any part of my legs. During the day my hands cramp when I'm holding a book, and this week I noticed I was getting a cramp in a back muscle while sitting--it was mild and worked itself out quickly.

I'll check with my neuro about Baclofen. I take Klonopin at night, and it's done nothing for this. I'm reluctant to take Quinine, but will ask neuro; and I guess I should add the Magnesium back, but it wasn't all that helpful the first time through. I have no idea why they went away last month.

More ideas?

Taking just magnesium for leg cramps is not enough. You need a product that contains magnesium carbonate and calcium carbonate. If you can find dolomite anywhere, that is the right one to take.

for electrolytes, ASAP.

Biaxin and Septra are major depleters for B-complex.
Biaxin also depletes inositol and B-complex.

These drugs are not innocuous. Also whatever you are taking in nasal form may be going into the brain directly to some extent, exerting a systemic effect.

I would say right now, your body is highly stressed.

Do you have a snack before bedtime? I would try that, as simple as it seems,
to see if this is a low blood sugar effect.

Here is a good overview of cramping:
http://www.medicinenet.com/muscle_cramps/page2.htm

I am thinking this is too much T3 for you. Something is metabolically off... and this is the most recent change. I think you need some more testing, in this area.