Intercostal Muscle Spasm Management — SCE Palliative Medicine MCQ

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ModeratePain ManagementIntercostal Muscle Spasm ManagementSCE Palliative Medicine

A 75‑year‑old woman with advanced lung cancer has developed painful, involuntary intercostal muscle spasms from chest wall tumour invasion that disrupt her sleep. What is the most appropriate muscle relaxant?

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Correct answer: E — Baclofen 5 mg three times daily increasing as tolerated — reduces skeletal muscle spasm via GABA‑B agonism centrally

Baclofen is the appropriate first‑line muscle relaxant for painful skeletal muscle spasm in UK palliative practice, with guidelines endorsing starting at low dose (5 mg bd–tds) and titrating as tolerated ([thamesvalleycanceralliance.nhs.uk](https://thamesvalleycanceralliance.nhs.uk/wp-content/uploads/2021/04/Cancer-Supportive-Palliative-Care-Guidelines-for-PAIN-revision-October-2012.pdf?utm_source=openai)). It specifically treats tumour‑related spasm, whereas quinine is limited to nocturnal cramps and contraindicated here ([thamesvalleycanceralliance.nhs.uk](https://thamesvalleycanceralliance.nhs.uk/wp-content/uploads/2021/04/Cancer-Supportive-Palliative-Care-Guidelines-for-PAIN-revision-October-2012.pdf?utm_source=openai)). Dantrolene risks hepatotoxicity and is used mainly in neurological/spasticity contexts, not focal tumour‑related spasms. Botulinum toxin injection into multiple intercostal muscles is invasive, resource‑intensive, and unsuitable. Tizanidine has hypotensive risks in elderly and lacks UK palliative endorsement for this indication.

Reference: Cancer Supportive & Palliative Care Guidelines – Skeletal muscle spasm (Thames Valley Cancer Alliance, 2012) & NHS “About baclofen” page, https://thamesvalleycanceralliance.nhs.uk/wp-content/uploads/2021/04/Cancer-Supportive-Palliative-Care-Guidelines-for-PAIN-revision-October-2012.pdf