Question

Muscle pain has always been a significant part of my ME/CFS. But I’ve now developed painful episodes of muscle cramp — especially at night. My GP has prescribed quinine —which has helped a bit. Is there anything else you can recommend that might help?

Answer

Leg cramps are quite commonly reported by people with ME/CFS and there are several approaches to management that are worth trying. Gentle exercises can be very helpful — if you can do them.

It's worth learning one of the stretching exercises that can help with prevention and if you are being woken by cramp in the middle of the night. Making sure you are not dehydrated is also important. A simple guide to hydration is the colour of your urine — which should be clear or a very pale yellow colour — dark yellow urine is a sign of dehydration.

Quinine tablets, which you have been prescribed, are certainly worth a try if all else fails. Quinine is a constituent of tonic water where the dose is obviously much smaller but quinine doesn't help everyone with cramp and it can produce side-effects, some of which overlap with ME/CFS symptoms (e.g., tinnitus, headaches and confusion) and could occur if you exceed the stated dose.

Muscle relaxant drugs, such as Baclofen, are also sometimes used for more severe cases of cramp or muscle spasm or muscular aches and pains. These are only available on prescription and they also have side-effects.

More information

• The use of the drugs mentioned above is covered in the Treatment section of the ME Association's  ME/CFS/PVFS Clinical & Research Guide (The ‘Purple Book').
• There is more detailed information on the prevention and treatment of cramp on the NHS Choices website.