BackgroundMuscle cramps are common in patients with cirrhosis. Despite their prevalence and impact on health‐related quality of life, there are no widely used clinical practice guidelines for management of muscle cramps in cirrhosis. The aim of this review was to critically evaluate current evidence regarding treatment of muscle cramps in cirrhosis.MethodsA systematic review using PubMed, MEDLINE (Ovid), Embase, and Scopus databases was performed on 30 June by two independent reviewers to identify randomised controlled trials (RCTs) reporting interventions for muscle cramps in cirrhotic patients.ResultsTwelve RCTs evaluating 13 distinct interventions were identified. Baclofen, methocarbamol, orphenadrine, and taurine supplementation reduced cramp frequency, severity, and duration when compared to placebo. Human albumin, pregabalin, and quinidine reduced cramp frequency compared to placebo. Pickle juice reduced cramp severity compared to placebo. BCAA supplementation and calcium carbonate were found to reduce cramp frequency compared to baseline. Stretching demonstrated a signal towards reducing cramp severity and frequency, and meditation had a signal towards reducing severity only when compared to baseline. Electro‐acupuncture was the only intervention which demonstrated no therapeutic effect. Pregabalin was the only agent associated with significant side effects that limited its use.ConclusionMethocarbamol, orphenadrine, and taurine supplementation were found in placebo‐controlled RCTs to be effective in reducing cramp frequency, severity, and duration in cirrhotic patients. All other interventions reported aside from electro‐acupuncture demonstrated a positive impact on cramps. High‐quality RCTs are needed to further investigate the use of these treatments in terms of comparative efficacy and safety.

中文翻译：

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肝硬化患者肌肉痛性痉挛的管理：随机对照试验的系统评价


背景肌肉痉挛在肝硬化患者中很常见。尽管它们普遍存在并影响与健康相关的生活质量，但没有广泛使用的临床实践指南来管理肝硬化肌肉痛性痉挛。本综述的目的是批判性地评价目前关于肝硬化肌肉痛性痉挛治疗的证据。方法6 月 30 日，两名独立评价员使用 PubMed、MEDLINE （Ovid）、Embase 和 Scopus 数据库进行了系统评价，以确定报告肝硬化患者肌肉痛性痉挛干预措施的随机对照试验 （RCT）。结果确定了 12 项评估 13 种不同干预措施的 RCT。与安慰剂相比，补充巴氯芬、美索巴莫、奥芬那君和牛磺酸可降低痛性痉挛的频率、严重程度和持续时间。与安慰剂相比，人白蛋白、普瑞巴林和奎尼丁降低了痛性痉挛频率。与安慰剂相比，泡菜汁减轻了痛性痉挛的严重程度。与基线相比，发现 BCAA 补充剂和碳酸钙可降低痛性痉挛频率。伸展运动显示出降低痉挛严重程度和频率的信号，而冥想仅在与基线相比具有降低严重程度的信号。电针是唯一没有显示治疗效果的干预措施。普瑞巴林是唯一与限制其使用的显著副作用相关的药物。结论在安慰剂对照 RCT 中发现补充美托巴莫、奥芬那君和牛磺酸可有效降低肝硬化患者痛性痉挛的频率、严重程度和持续时间。除电针外，所有其他报告的干预措施均显示出对痛性痉挛的积极影响。 需要高质量的 RCT 来进一步研究这些治疗在比较疗效和安全性方面的使用。