Muscle Pain

Muscle spasm vs Twitch

Increased tone

twitching is short and mild

Cramp - painful spasmodic contraction

Tremor

Muscle sprain and strain

Pathophysiology of Spasticity

Muscle spasm cycle

Alpha-Gamma Linkage

Management

Lifestyle

Muscle Relaxants

Peripherally acting

Centrally acting

Direct (locally) acting

Tizanidine (Zanaflex, Tizagelan, Zolud) 2mg or 4mg

alpha-2 adrenergic receptor agonist, similar to clonidine for Spasticity associated with multiple sclerosis or spinal cord injury or disease

Initially 2 mg daily, then increased in steps of 2 mg daily in divided doses, increased at intervals of at least 3–4 days and adjust according to response; usual dose up to 24 mg daily in 3–4 divided doses; maximum 36 mg per day.

Monitor liver function monthly for first 4 months for daily doses of 12 mg or higher, and in those who develop unexplained nausea, anorexia or fatigue.