Prevalence and Morbidity Associated With Muscle Cramps in Patients With Cirrhosis

Abstract

PURPOSE-Patients with cirrhosis often experience muscle cramps with varying severity. We investigated the factors associated with the prevalence and morbidity associated with muscle cramps.METHODS-A total of 150 adult patients with cirrhosis were enrolled consecutively. Cramp questionnaire with visual analogue scale for pain, Chronic Liver Disease Questionnaire (CLDQ), and blood for measurement of 25-(OH) vitamin D levels were obtained after informed consent.RESULTS-A total of 101 patients (67%) reported muscle cramps in the preceding 3 months. Patients with cramps had significantly lower serum albumin (3.1 ± 0.6 g/dL vs 3.3 ± 0.7 g/dL, P = .04) and CLDQ scores (107 ± 37 vs 137 ± 34, P < .0001) compared with those without cramps. The median composite symptom score, defined as product of frequency and severity of cramps, in the study cohort was 12 with a range of 0.3 to 200. There were no clinical or biochemical predictors for occurrence of any cramps or severe cramps (composite symptom score > 12). Muscle cramps (P < .001) and hepatic encephalopathy (P = .009) were associated independently with decreased CLDQ scores. Vitamin D deficiency was seen in 66% of the study cohort, but the serum 25-(OH) vitamin D levels were not significantly different between patients with and without cramps (18.0 ± 8.9 ng/mL vs 19.6 ± 9.5 ng/mL, P = .49).CONCLUSIONS-Muscle cramps are associated with significantly diminished quality of life in patients with cirrhosis. More research is needed to better understand their mechanism to develop effective treatment. KeywordsChronic liver disease questionnaire; Cirrhosis; Muscle crampsThe association of muscle cramps with cirrhosis was first reported by Konikoff and Theodor 1 in 1986 when they made their observation of repeated painful muscle cramps by patients with cirrhosis. They proposed that the strikingly high incidence and uniformity of the phenomenon may justify the inclusion of painful muscle cramps among the recognized symptoms of cirrhosis. 1 Subsequently, several studies have confirmed that muscle cramps are a common symptom of cirrhosis. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript them as sudden, uncomfortable squeezing or contraction of a muscle, lasting seconds to minutes. An electromyogram of a cramping muscle reveals involuntary repetitive firing of motor unit action potentials at high rates (up to 150 per second) producing a sustained muscle contraction. 5,6 These cramps are not associated with any progressive motor neuron disease or chronic neuromuscular disability and are different from muscle contracture, dystonia, and tetany. 5,6 The prevalence is varied and ranges from 29% to 88% depending on the inclusion criteria used by the investigators. 2,3,[7][8][9] The exact mechanism behind the occurrence of muscle cramps remains elusive. 10 Potential primary hypotheses include neurologic, muscular, endocrine, or electrolyte imbalance. 2,4,[9][10][11] Diuretic use in cirrhotic patients also has been implicated as a cause of muscle cramps thro...

Effects of L-carnitine supplementation on the quality of life in diabetic patients with muscle cramps

“…L-carnitine supplementation resulted in a decrease in the frequency of muscle cramps and in Wong-Baker FACES ® Pain Rating Scale score, and associated with an increase in the scores on the BP, VT, SF, and RE subscales of the SF-36. Several previous studies have also shown that L-carnitine supplementation is commonly utilized in patients with inborn errors of carnitine metabolism and muscular carnitine deficiency [11], hemodialysis patients with muscular symptoms [3], and cirrhosis patients who experience muscle cramps [14].…”

“…to Wong-Baker FACES ® Pain Rating Scale that ranged from 0 (no hurt) to 5 (hurts worst) [14]. The Wong-Baker FACES ® Pain Rating Scale was originally published in Whaley & Wong's Nursing Care of Infants and Children.…”

Intradialytic Massage for Leg Cramps Among Hemodialysis Patients: a Pilot Randomized Controlled Trial

“…(18) These questions ask patients to report on cramp frequency, location, duration, and severity separately for cramps during dialysis treatment and for cramps that occur at home following dialysis. (19,20,21) We further tested our instruments on a group of three dialysis patients who met all study eligibility criteria. The pretest subjects completed all study tasks as outlined below for the full trial, with the exception of receiving only one massage.…”

Pharmacological Therapy of Ascites

“…Other complications of diuretic therapy include hepatic encephalopathy, electrolyte disorders, gynaecomastia, and muscle cramps [13, [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. If cramps are severe, diuretic dose should be decreased or stopped, and albumin infusion [37], baclofen, and l-carnitine may relieve symptoms [23][24][25][26][27]37].…”