Benztropine for acute muscle spasm in the emergency department.

Many patients arrive in the emergency department with acute lumbar and cervical muscle spasm (focal dystonia) that occurs either spontaneously or secondary to nonimpact axial injuries (i.e., lifting and twisting). Current treatment options, such as opioids, NSAIDs and anxiolytics, provide either minimal or no relief or precipitate undesirable side effects. My hypothesis was that benztropine, an anticholinergic medication, would reverse the state of muscle spasm and thus provide good pain relief for these patients. Entry criteria for this study were age between 16 and 50 years, no prior lumbar or cervical problems such as arthritis or herniated discs, no previous injury in the affected area and onset of muscle spasm symptoms within the 24 hours preceding presentation. I treated 8 patients during 1999 who met these criteria: 5 had acute cervical torticollis, and 3 had paralumbar muscle spasm. All of the patients were asked to rate their pain using a visual analogue scale (0 to 10) on presentation and at discharge. Their range of motion — flexion, extension and bilateral rotation — was determined also on presentation and at discharge. Most of the patients had nonimpact axial injuries, either from lifting or twisting or from hyperextension or hyperflexion related to motor vehicle accidents or sports-related Benztropine for acute muscle spasm in the emergency department