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Review
, 2012 (9), CD009402

Magnesium for Skeletal Muscle Cramps

Affiliations
Review

Magnesium for Skeletal Muscle Cramps

Scott R Garrison et al. Cochrane Database Syst Rev.

Abstract

Background: Skeletal muscle cramps are common and often presented to physicians in association with pregnancy, advanced age, exercise or disorders of the motor neuron (such as amyotrophic lateral sclerosis). Magnesium supplements are marketed for the prophylaxis of cramps but the efficacy of magnesium for this indication has never been evaluated by systematic review.

Objectives: To assess the effects of magnesium supplementation compared to no treatment, placebo control or other cramp therapies in people with skeletal muscle cramps.

Search methods: We searched the Cochrane Neuromuscular Disease Group Specialized Register (11 October 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (2011, Issue 3), MEDLINE (January 1966 to September 2011), EMBASE (January 1980 to September 2011), LILACS (January 1982 to September 2011), CINAHL Plus (January 1937 to September 2011), AMED (January 1985 to October 2011) and SPORTDiscus (January 1975 to September 2011).

Selection criteria: Randomized controlled trials (RCTs) of magnesium supplementation (in any form) to prevent skeletal muscle cramps in any patient group (i.e. all clinical presentations of cramp). We considered comparisons of magnesium with no treatment, placebo control, or other therapy.

Data collection and analysis: Two authors independently selected trials for inclusion and extracted data. Two authors assessed risk of bias. We attempted to contact all study authors and obtained patient level data for three of the included trials, one of which was unpublished. All data on adverse effects were collected from the included RCTs.

Main results: We identified seven trials (five parallel, two cross-over) enrolling a total of 406 individuals amongst whom 118 cross-over participants additionally served as their own controls. Three trials enrolled women with pregnancy-associated leg cramps (N = 202) and four trials enrolled idiopathic cramp sufferers (N = 322 including cross-over controls). Magnesium was compared to placebo in six trials and to no treatment in one trial.For idiopathic cramps (largely older adults presumed to have nocturnal leg cramps), differences in measures of cramp frequency, magnesium versus placebo, were small, not statistically significant, and without heterogeneity (I(2) = 0%). This includes the primary endpoint, percentage change from baseline in the number of cramps per week at four weeks (-3.93%, 95% confidence interval (CI) -21.12% to 13.26%, moderate quality evidence) and the difference in the number of cramps per week at four weeks (0.01 cramps/week, 95% CI -0.52 to 0.55, moderate quality evidence). The percentage of individuals experiencing a 25% or better reduction in cramp rate from baseline was also no different, being 8% lower in the magnesium group (95% CI -28% to 12%, moderate quality evidence). Similarly, no statistically significant difference was found at four weeks in measures of cramp intensity (moderate quality evidence) or cramp duration (low quality evidence).Meta-analysis was not possible for trials of pregnancy-associated leg cramps. The single study comparing magnesium to no treatment failed to find statistically significant benefit on a three-point ordinal scale of overall treatment efficacy. The two trials comparing magnesium to placebo differed in that one trial found no benefit on frequency or intensity measures while the other found benefit for both.Withdrawals due to adverse events were not significantly different than placebo. While we could not determine the number of subjects with minor adverse events, studies of oral magnesium generally described potential side effects as similar in frequency to placebo.

Authors' conclusions: It is unlikely that magnesium supplementation provides clinically meaningful cramp prophylaxis to older adults experiencing skeletal muscle cramps. In contrast, for those experiencing pregnancy-associated rest cramps the literature is conflicting and further research in this patient population is needed. We found no randomized controlled trials evaluating magnesium for exercise-associated muscle cramps or disease state-associated muscle cramps (for example amyotrophic lateral sclerosis/motor neuron disease).

Conflict of interest statement

Drs Garrison and Khan are co‐authors of a RCT which was included in this review. None of the co‐authors of this review have links, financial or otherwise, to any company or special interest group that is involved in the marketing of magnesium or other cramp related therapies.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Forest plot of comparison: 1 Idiopathic rest cramps, magnesium versus placebo, outcome: 1.1 % Change in cramp frequency from baseline at 4 weeks.
4
4
Forest plot of comparison: 1 Idiopathic rest cramp efficacy, magnesium versus placebo, outcome: 1.3 Proportion of subjects with a ≥ 25% reduction in cramp frequency at 4 weeks.
5
5
Forest plot of comparison: 1 Idiopathic rest cramps, magnesium versus placebo, outcome: 1.6 Number of cramps per week at 4 weeks.
6
6
Forest plot of comparison: 1 Idiopathic rest cramp efficacy, magnesium versus placebo, outcome: 1.7 Cramp intensity (pain) on a 3 point scale (1 = mild, 2 = moderate, 3 = severe) at 4 weeks.
1.1
1.1. Analysis
Comparison 1 Idiopathic rest cramp efficacy, magnesium versus placebo, Outcome 1 % Change in cramp frequency from baseline at 4 weeks.
1.2
1.2. Analysis
Comparison 1 Idiopathic rest cramp efficacy, magnesium versus placebo, Outcome 2 % Change in cramp frequency from baseline at 12 weeks.
1.3
1.3. Analysis
Comparison 1 Idiopathic rest cramp efficacy, magnesium versus placebo, Outcome 3 Proportion of subjects with a ≥ 25% reduction in cramp frequency at 4 weeks.
1.4
1.4. Analysis
Comparison 1 Idiopathic rest cramp efficacy, magnesium versus placebo, Outcome 4 Proportion of subjects with a ≥ 25% reduction in cramps at 12 weeks.
1.5
1.5. Analysis
Comparison 1 Idiopathic rest cramp efficacy, magnesium versus placebo, Outcome 5 Number of cramps per week at 4 weeks.
1.6
1.6. Analysis
Comparison 1 Idiopathic rest cramp efficacy, magnesium versus placebo, Outcome 6 Number of cramps per week at 12 weeks.
1.7
1.7. Analysis
Comparison 1 Idiopathic rest cramp efficacy, magnesium versus placebo, Outcome 7 Cramp intensity (pain) on a 3 point scale (1 = mild, 2 = moderate, 3 = severe) at 4 weeks.
1.8
1.8. Analysis
Comparison 1 Idiopathic rest cramp efficacy, magnesium versus placebo, Outcome 8 Cramp intensity (pain) on a 3 point scale (1 = mild, 2 = moderate, 3 = severe) at 12 weeks.
1.9
1.9. Analysis
Comparison 1 Idiopathic rest cramp efficacy, magnesium versus placebo, Outcome 9 Proportion of subjects rating their cramps as moderate or severe (i.e. ≥ 2 on the 3 point intensity scale) at 4 weeks.
1.10
1.10. Analysis
Comparison 1 Idiopathic rest cramp efficacy, magnesium versus placebo, Outcome 10 Proportion of subjects rating their cramps as moderate to severe (i.e. with mean cramp intensity ≥2 on the 3 point intensity scale) at 12 weeks.
1.11
1.11. Analysis
Comparison 1 Idiopathic rest cramp efficacy, magnesium versus placebo, Outcome 11 Proportion of subjects with the majority of cramp durations ≥ 1 minute at 4 weeks.
1.12
1.12. Analysis
Comparison 1 Idiopathic rest cramp efficacy, magnesium versus placebo, Outcome 12 Proportion of subjects with majority of cramp durations ≥ 1 minute at 12 weeks.
2.1
2.1. Analysis
Comparison 2 Adverse effects of treatment, magnesium versus placebo, Outcome 1 Withdrawals due to adverse events.
2.2
2.2. Analysis
Comparison 2 Adverse effects of treatment, magnesium versus placebo, Outcome 2 Number of subjects with major adverse events.
2.3
2.3. Analysis
Comparison 2 Adverse effects of treatment, magnesium versus placebo, Outcome 3 Number of subjects with minor adverse events.

Update of

  • Cochrane Database Syst Rev. doi: 10.1002/14651858.CD009402

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