In How to Manage MS-Related Spasticity, we discussed different therapeutic strategies to combat spasticity. Conservative approaches can be quite effective in combatting mild spasticity, including stretching and strengthening exercises. Oral medications such as BACLOFEN are often effective, especially in the early stages of the disease.
* Stretching and range of motion exercises can treat connective tissue tightness. Stretches should focus on a single muscle group. Hold for 30 seconds, rest, and repeat 3-5 times. NO BOUNCING ALLOWED.
* Yoga, Tai Chi and biofeedback may be appropriate relaxation interventions. Swimming and aquatic exercises may also be helpful.
* Problems with co-contractions can be treated with timing exercises and by focusing on motor control.
* Strength training can assist with the timing of movements, depending on the strength or weakness of the agonist/antagonist muscles.
* Strengthening can be achieved in a variety of ways, using free weights, machines, theraband, Swiss Balls, or aquatic exercises.
* General conditioning can help to strengthen weak and deconditioned muscle groups and increase endurance and cardiovascular conditioning.
* Pain may be alleviated or reduced by stretching, transcutaneous electrical nerve stimulation (TENS), or thermal modalities such as cooling.
Early in my MS career, I told the neurologist that I was experiencing unusual tightness in my calves. His recommendations were yoga, swimming, plenty of fluids and potassium-rich foods. These strategies helped somewhat, but not completely, and I certainly didn’t know how to properly stretch my muscles.
At home, I would talk about how knotted my calves were and the response I received was something like this: “Good grief, Lisa!! What did you do?” My response: “Absolutely nothing, and this is not as bad as it usually gets.”
So it wasn’t until the enormous, never-ending (seemingly) relapse I experienced last winter/spring that the neurologist and I discussed spasticity. Basically, the back of my legs were pulled so tight that I couldn’t extend them to stand straight. It was excruciating.
Also, I couldn’t stand from a chair or the sofa without pulling on a table. On Day 3 of a 5-day course of IV Solumedrol, I actually could stand up from a seated position. The moment was thrilling!!
A month later the spasticity was returning and my neurologist prescribed Oral baclofen (Linosenil®). Following the titration schedule described below, I found a therapeutic level. At first I did experience increased fatigue as a side effect, but that dissipated after 3-5 days. I was so nice when my legs could be completely straightened and I could walk more easily. The increased mobility was most welcome.
BACLOFEN has been part of my pharmacological arsenal for the past year. But I must say that since beginning regular physical therapy sessions with a specialist in neurological disorders, I have not needed as much medication to combat the spasticity. I now know how to stretch properly, even how to get some of the really awkward spots to let loose. The strengthening exercises have helped to improve muscle tone and the conditioning activities has increased overall health and well-being.
So, for me, a combination of spasticity-relieving strategies has been most helpful. If spasticity is interfering with your daily functioning and causes pain, talk to your doctor to discuss treatment options. Medication may not be the answer for you.
Resources for Stretching and Exercise
Fowler, J. (2003). Everybody stretch: A physical activity workbook for people with various levels of multiple sclerosis. Multiple Sclerosis Society of Canada.
Gibson, B. E. (2004). Stretching for people with MS: An illustrated manual. National Multiple Sclerosis Society.
Gibson, B. E. (2002). Stretching with a helper for people with MS: An illustrated manual. National Multiple Sclerosis Society.
BACLOFEN acts on the central nervous system to relieve spasms, cramping, and tightness of muscles caused by spasticity in multiple sclerosis.
People with MS are usually started on an initial dose of 5 mg every six to eight hours. If necessary, the amount is increased by 5 mg per dose every five days until symptoms improve. The goal of treatment is to find a dosage level that relieves spasticity without causing excessive weakness or fatigue. The effective dose may vary from 15 mg to 160 mg per day or more.
If you are taking more than 30 mg daily, do not stop taking this medication suddenly. Stopping high doses of this medication abruptly can cause convulsions, hallucinations, increases in muscle spasms or cramping, mental changes, or unusual nervousness or restlessness. Consult your physician about how to reduce the dosage gradually before stopping the medication completely.
This drug adds to the effects of alcohol and other CNS depressants (such as antihistamines, sedatives, tranquilizers, prescription pain medications, seizure medications, other muscle relaxants), possibly causing drowsiness. Be sure that your physician knows if you are taking these or other medications.
Studies of birth defects with BACLOFEN have not been done with humans. Studies in animals have shown that BACLOFEN, when given in doses several times higher than the amount given to humans, increases the chance of hernias, incomplete or slow development of bones in the fetus, and lower birth weight.
BACLOFEN passes into the breast milk of nursing mothers but has not been reported to cause problems in nursing infants.
Possible Side Effects
Side effects that typically go away as your body adjusts to the medication and do not require medical attention unless they continue for several weeks or are bothersome: drowsiness or unusual tiredness*; increased weakness*; dizziness or lightheadedness; confusion; unusual constipation*; new or unusual bladder symptoms*; trouble sleeping; unusual unsteadiness or clumsiness*.
Unusual side effects that require immediate medical attention: fainting; hallucinations; severe mood changes; skin rash or itching.
Symptoms of overdose: sudden onset of blurred or double vision*; convulsions; shortness of breath or troubled breathing; vomiting.
*Since it may be difficult to distinguish between certain common symptoms of MS and some side effects of BACLOFEN, be sure to consult your health care professional if an abrupt change of this type occurs.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.