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Debilitating muscle cramps common among patients with cirrhosis

Many patients with cirrhosis experienced painful muscle cramps that significantly reduced their quality of life, but investigators observed no significant predictors for cramps in a recent study.

Researchers evaluated the incidence of muscle cramps in 150 patients with cirrhosis. Participants responded to a questionnaire regarding pain severity, location and other characteristics of their cramps, along with a Chronic Liver Disease Questionnaire (CLDQ), which measures 29 factors affecting quality of life on a scale of 1-7, with lower scores indicating poorer quality of life.

Cramps were experienced by 101 patients in the 3 months prior to enrollment. The most common cramp locations were in the lower half of the body, including calves (70% of patients), toes (50%) and thighs (43%), with other locations including fingers (47%), the abdominal wall (12%) and neck (9%). Participants reported experiencing cramps once per week in 24% of cases, multiple times weekly in 39% of cases, once daily in 18% and several times a day in 20%, with more than half (62%) indicating severe pain.

Patients with cramps had lower CLDQ scores (107 ± 37 vs. 137 ±34, P<.0001) and serum albumin levels (3.1 ± 0.7 g/dL vs. 3.3 ± 0.7 g/dL, P=.04) than those who did not experience cramps. Investigators noted independent associations between reduced CLDQ scores and muscle cramps (P<.001) and hepatic encephalopathy (P=.009) via multivariate analysis. A composite symptom score (CSS), reached by multiplying frequency of weekly cramps by the value assigned to their severity via the questionnaire, varied from 0.3 to 200 (median 12).

“Patients with cirrhosis often report muscle cramps with varied frequency and severity,” the researchers wrote. “Because of the intermittent nature of the symptoms, lack of objective findings and inability to measure an individual’s predisposition to muscle cramping by means of any diagnostic tool, these symptoms are often dismissed. … [However,] their occurrence is associated with a significant decrease in health-related quality of life. Further studies need to be conducted to systematically evaluate the therapeutic efficacy of various agents, possibly using the CSS and threshold frequency as additional study outcome measures.”