Topical Treatments for Muscle Spasm

First-Line and Second-Line Treatments

Over-the-counter topicals containing camphor or menthol in combination with methyl salicylate are recommended as first-line topical treatments for muscle spasm, according to the Mayo Clinic Proceedings 1, 2, 3
Diclofenac 1% gel can be used as a second-line treatment when first-line treatments are ineffective, as suggested by the Mayo Clinic Proceedings 1, 2
Capsaicin cream applied to affected areas 3-4 times daily can help relieve muscle spasm through desensitization of TRPV1 receptors, leading to decreased release of pain-transmitting neurotransmitters, as noted by the Mayo Clinic Proceedings 2, 3

Compounded lidocaine cream or ointment can be effective for muscle pain, and lidocaine patches may be more effective than creams as they deliver medication gradually over 12-24 hours, according to the Mayo Clinic Proceedings 4, 5
Compounded amitriptyline-ketamine mixture can help relieve muscle spasm by blocking sodium channels and antagonizing N-methyl-D-aspartate receptors in peripheral nociceptive afferents, as suggested by the Mayo Clinic Proceedings 4, 6
Compounded gabapentin 6% ointment may be used to relieve muscle spasm, as noted by the Mayo Clinic Proceedings 1, 2

Topical treatments should be tried for at least 4 weeks to properly assess efficacy before switching to another option, as recommended by the Mayo Clinic Proceedings 5
For patients with persistent or severe muscle spasms not responding to topical treatments, consider systemic treatments or referral to a pain specialist, according to the Mayo Clinic Proceedings and the Annual Review of Medicine 5, 7
Topical analgesics are generally safer than systemic medications as they have fewer systemic side effects, as noted by the Annual Review of Medicine 7