MS Clinical Nurse Practitioner Miranda Olding reveals the different treatment options for this common MS symptom
Spasticity, otherwise known as a tightening or stiffness of the muscle, is due to increased muscle tone and exaggerated response to muscle stretch. It is a common multiple sclerosis (MS) symptom and can affect the way we function, such as walking and posture. In addition, it can increase fatigue and cause pain. Unmanaged, it can lead to permanently shortened muscles called contractures and can affect daily living.
Spasticity also refers to involuntary muscle contractions or sudden movements, which range from a mild feeling of tightness, to severe, painful spasms, often of the legs. Here we focus on the problem of constant stiffness.
Treatment of spasticity is ideally done with the person with MS at the centre of a multidisciplinary team, with neuro physiotherapist, occupational therapist (OT), MS nurse, any relevant consultant, and possibly wheelchair services all liaising with each other.
The first thing to be aware of is that anything that is bothering the body can trigger or exacerbate spasticity in MS, so before medication, these 'trigger factors' need to be dealt with. They include, but are not limited to, infection, constipation, urinary retention, sore skin or pressure areas, anything that pinches, rubs or chafes, increased emotional stress and pain.
Muscle relaxant medication
The key with all muscle relaxants is to start low and go slow. You can even cut tablets in half with a tablet cutter from a pharmacy and start with a smaller dose. The idea is that by gradually increasing it every few days, you find a dose which reduces the problem, without causing too many side effects. The first people usually try is baclofen, and the most common side effects are drowsiness, or feeling weak. Because MS involves both stiffness and weakness in the muscles, you can find that a degree of stiffness is needed to maintain the strength needed for standing, so it can be a fine balance.
NICE guidelines recommend gabapentin as the next treatment to try if baclofen is not right for you. This is often used for nerve pain in MS, but also has a muscle relaxant effect. However, some people find the sedating side effects, or the fact that they are putting on weight, too difficult.
Another muscle relaxant that can be tried, which is less sedating, is tizanidine. But you will need a blood test before and for the first three months of treatment to check that your liver is coping and is not being harmed.
Occasionally, an older muscle relaxant, dantrolene, is tried. Diazepam (valium) is also effective as a short term muscle relaxant, but it is easy to become dependent on this. Clonazepam can also be tried.
When just a couple of defined muscles are causing the problems, botulinum toxin (botox) can be very effective when injected to paralyze these muscles. This needs to be repeated around every three months.
There has been evidence for some time that components of the cannabis plant can help some people with MS spasticity and pain. Sativex, the cannabis-derived medicine, is licensed to treat spasticity in people with MS, and is now available on NHS prescription from a specialist doctor, so speak to your neurologist or MS nurse to find out more. It is still illegal to possess this drug if you do not have a prescription.
CBD oil is a cannabis-based product that contains none of the psychoactive component, TCH, and so is legal for anyone to use. In studies where there was evidence of effectiveness, doses ranged from 0.8 to 1.8mg, taken between 2-4 times per day. The easiest way to control the dose is to take it in liquid form, and start with one drop under the tongue, then increase as necessary.
If other medications aren’t proving effective, a referral can be made to be seen in a specialist spasticity clinic, where a baclofen pump can be considered. This involves a tiny dose of baclofen being delivered straight to the spinal column via a small plastic tube, fitted to a pump, about the size of a shoe polish tin, which is inserted just under the skin in the abdomen. As the dose is so small, people have a lot less side effects than with tablets.
The way that you sit and lie in bed is important to break up the pattern of tight muscles with MS spasticity. However, this is something a physio or occupational therapists (OTs) can help with. OTs can also assist with night time splints to stretch out hands that have become very tight and to help ensure that all seating and equipment is supportive.
Keeping a full range of motion is important. Start by seeing a neuro-physio, and then keep things going with exercise. Everybody should be able to do some exercise or stretching, whether this is attending a regular exercise or yoga class, using regular or assisted gym equipment, including from a wheelchair, or even just passive stretching with a helper. A resource for this, 'Stretching with a helper' can be downloaded here https://bit.ly/2rrqHFu
Exercise not only helps to stretch out tight muscles, but also to reduce spasticity and spasm, boost fitness and lift mood.
A big congratulations to all the UK businesses who celebrated their fundraising success at the MS-UK 925 Challenge awards night on 28 November! Together they rasied over £14,500 for the charity!
Now in its second year, the challenge saw companies take part in a race against time to raise £925 in nine weeks, two days, and five hours.
Ready and raring to go, Essex-based print, design and mailing company, Direct Solutions, spead off into the lead and were the first to raise the target, and went on to raise the most money overall, totalling £2,118.
Other teams that took part include 4 Networking, Chameleon International Search Ltd, Click4Assistance Ltd, Green Square, Hart Wilcox Experiential Marketing, HSBC, Natwest, Scrutton Bland, Women In Business Neworking and Wivenhoe House Hotel. All of the teams were congratulated and thanked for their hard work at an awards ceremony at Marks Tey Hotel on Thursday 28 November.
Commenting on their win, Louise Parkes, Digital Marketing Executive at Direct Solutions said: ‘We took part in the 925 Challenge for MS-UK for the second year and were absolutely delighted to take home the trophy for the fastest team to raise the £925 and for the most money raised overall.
‘The challenge is such a creative and clever way of fundraising against the clock, add in the competitive elements between local and national businesses and you have a recipe for success!’
Sasha Mills from HSBC said, ‘MS-UK is a charity that is very close to my heart following my husband’s diagnosis in 2017. Since being introduced to MS-UK they have provided invaluable support through various means such as mindfulness courses, its wellness centre Josephs Court and the social events they put on so that we can meet other families living with MS.
‘When I heard about the 925 Challenge I was keen to get involved and enter a team from HSBC UK, as not only are they important to me personally, they are also a client of HSBC UK. I wanted to get involved to help support MS-UK not only by raising money but also awareness. MS is a condition that affects so many people, it is important to spread the word about the fantastic work the charity does. The 925 Challenge was great fun and it was a great way to have some fun and team building in the office with our pumpkin carving competition and bingo!’
Lots of fun was had by all 13 companies, with leg waxing, curry and karaoke nights, banner offers, ice bucket challenges, bake sales and much more taking place to raise the money. Lots of teamwork and creative thinking was required to come up with the winning ideas, with the motivational boost of helping people with MS.
Thanking everyone for their support MS-UK Fundraising Manager, Jill Purcell said: ‘It was lovely to see so many companies at the awards event last night. A huge well done to all the teams and congratulations to those that took away a trophy. Your efforts will help us to continue supporting people with multiple sclerosis to live happier and healthier lives.’
There were a number of awards up for grabs for this challenge and these are the winners of the different catagories:
Team Spirit Award
Awarded to Click4Assistance Ltd.
Alison Deal (Women in Business Networking)
Best Photo / Video
Hart Wilcox Experiential Marketing
Most Innovative Idea
Quirkiest Fundraising Idea
Most Unlikely Hero
Chris Ives (4Networking)
Most Money Raised
First Team To Raise £925
There are only 22 days left until Christmas and, if you’re anything like us here at MS-UK, you’ll be wondering what on earth to buy for your loved ones.
If that’s the case, listen up. Today is known as Cyber Monday, a term coined in the US for when retailers have huge online sales in a bid to get us all clicking and, if you plan to nab some bargains, you could help raise money for MS-UK at no extra cost – what’s not to love?
Retail giant Amazon runs a scheme called Amazon Smile and, if you sign up and choose MS-UK as your nominated charity, they will donate 0.5% of the net purchase price (excluding VAT, returns and shipping fees) to our charity, providing MS-UK is selected as the beneficiary.
This means that by just shopping normally, you will be generating money that allows us to continue to help people with MS live happier and healthier lives, through our services such as the MS-UK helpline, Counselling, New Pathways magazine and our wellness centre Josephs Court.
How to sign up
1) Log onto https://smile.amazon.co.uk/ch/1033731-0 using your usual Amazon log in details
2) This will take you to a screen where you can search and select MS-UK as your chosen charity
3) Start shopping!