In a CMAJ research letter, Norman Epstein described 8 patients with acute muscle spasm.1 The diagnosis appears to have been based on subjective measurements of range of motion and pain; Epstein did not state how range of motion and tenderness were measured.
There is no proof that pain symptoms or decreased range of motion result directly from abnormality or spasm of muscles. There is no gold standard for diagnosing paralumbar spasm. There is no electrodiagnostic test or other objective investigation to prove that muscles are abnormal. There is also no medical literature proving that muscle spasm, especially paralumbar spasm, can be diagnosed clinically with scientific validity or reliability.
As E.W. Johnson writes, “In spite of overwhelming evidence that skeletal muscle spasm is nonexistent, physicians are continually deluged with seductive ads to prescribe expensive muscle relaxants.”2 I agree that a randomized, blinded, placebo-controlled trial is needed to corroborate the findings in this case series.
Signature
Perry Rush
Department of Rehabilitation Medicine University of Toronto Toronto, Ont.
References
- 1.Epstein NL. Benztropine for acute muscle spasm in the emergency department. CMAJ 2001;164(2):203-4. [PMC free article] [PubMed]
- 2.Johnson EW. The myth of skeletal muscle spasm. Am J Phys Med Rehabil 1989;68:1. [DOI] [PubMed]