If you have myasthenia gravis (MG), you’re no stranger to muscle weakness. But if you’re feeling muscle pain and cramps too, you’re not alone.

Myasthenia gravis is a chronic autoimmune condition. It causes weakness in your skeletal muscles (the muscles that help you move) by attacking your neuromuscular junctions. Each neuromuscular junction is a spot where your nervous system contacts your muscles.

But muscle pain (also called myalgia) or cramps aren’t the same as muscle weakness or fatigue. If you feel painful discomfort, you may need other ways to reduce the achiness.

Here, we offer six tips for managing MG-related muscle pain or cramps.

How Myasthenia Gravis Triggers Muscle Pain and Cramps

First, it’s important to understand why you may feel a cramp or pain. If you have myasthenia gravis, you probably take some type of anticholinesterase, also called cholinesterase inhibitor (AChEls). These medications stop the breakdown of acetylcholine, the neurotransmitter responsible for helping your muscles contract.

While these medications combat muscle weakness, existing research links cholinesterase inhibitors to muscle cramps and pain. One study evaluated 420 people taking pyridostigmine, a cholinesterase inhibitor commonly prescribed to treat MG. Between 30 percent and 40 percent reported muscle cramps.

In general, the appearance of pain or cramps follows the same pattern as your MG symptoms. Your eyes and face may feel discomfort first. As muscle weakness spreads through your body, cramps and pain are also possible in your neck, arms, and legs.

Other frequently prescribed medications, including azathioprine, cyclosporine, or corticosteroids like prednisone, typically don’t increase your risk of muscle pain or cramps. Still, there are several other medications you may need to avoid because they cause your muscle weakness to worsen.

6 Tips for Managing Muscle Pain and Cramps

Everyone’s experience with myasthenia gravis is different. That includes how and where you may feel pain or cramps. So, it’s important to find the discomfort relief technique that works best for you. If you’re looking for an option other than over-the-counter acetaminophen or ibuprofen, here are some management strategies that have worked for other MGteam members.

1. Exercise Consciously, Stretch, and Massage Your Muscles

Exercise is good for your muscles, though it is important not to overdo it. You can reduce cramps by stretching your muscles and gently massaging them. Massage relieves muscle pain and cramps by improving blood flow to your muscles and reducing any tightness you may feel. In some cases, massage can release your endorphins, the chemicals that work as your body’s natural painkillers.

Some MGteam members confirm that pairing stretching and massage helps reduce their muscle discomfort.

“I go to the chiropractor every three weeks. He knows I have MG, so he gave me some stretching exercises to do every day. He said it’s important to keep moving those muscles,” one member wrote. “For my leg cramps, I use a muscle massager every night before bed.”

2. Give Ice a Try

Some muscle pain and cramps respond well to cold temperatures. It can sometimes help numb your discomfort and reduce swelling or inflammation. Other times, you may want a temperature change to get your mind off how you’re feeling.

If a cramp or pain hits during the day, it may be easiest to grab a quick ice pack. Hold it against your muscles until they feel better. In the evening, you can try a cold bath or shower to combat the soreness. Some people have pain or cramps that wake them at night. To limit the impact on your sleep, consider keeping ice packs in a cooler or small refrigerator in your bedroom.

3. Use a Heating Pad

Cold temperatures don’t work for everyone. If using an ice pack or taking a cold shower makes you shiver, that can trigger more muscle pain. To avoid that problem, try applying heat instead. Putting something warm against a painful spot on your body attracts more blood to that area, reducing your cramps.

One MGteam member says pairing heat with over-the-counter medication can be effective: “I had bad aching in my forearms to the point that I had to take a large dose of ibuprofen. Then, I wrapped my arms in a heating pad until the pain subsided.”

Be mindful of how long you use a heating pad, though. Heat can worsen your MG symptoms. While this effect typically happens if you get overheated outside, you should still pay attention to how your body responds to heat therapy.

4. Try a Muscle Rub Made From Natural Ingredients

Many people are interested in using natural products for pain relief. “I’m always researching what I can do naturally to help,” one member wrote.

Muscle rubs, bath soaks, or lotions that contain natural ingredients like arnica, calendula, eucalyptus, or peppermint have muscle-relaxing properties. Check with your doctor before using these products because they may interact with your skin or other medications you take.

You can also try meditation as another natural treatment for MG-related pain.

5. Drink More Water

If you’re dehydrated and don’t drink enough water, you’re more likely to experience muscle cramps and pain. Dehydration boosts your risk of getting muscle cramps in several ways. Without enough water, you can experience:

• An electrolyte imbalance — Abnormal levels of sodium, potassium, and calcium make your muscles more likely to cramp.
• Muscle fatigue — Without enough water, your muscles tire faster, increasing the chance of pain and cramping.
• Reduced blood flow — Low blood flow can cause high blood pressure, triggering muscle cramps.

The exact amount of water you need to prevent dehydration varies based on your age, weight, and activity level. Conventional wisdom is that you need at least eight glasses of water every day. Talk with your doctor about the right amount of water for you.

6. Talk With Your Doctor About Muscle Pain

Although it’s not uncommon for people with myasthenia gravis to get muscle cramps, the condition may not always be the cause of your discomfort. If you regularly get cramps or feel pain — or these problems just started — talk with your doctor.

You may have another health condition that can trigger muscle cramps or pain. If that’s the case, you’ll need treatment. Your doctor may examine you for:

• Diabetes
• Kidney disease
• Diseases affecting the muscles or nerve signals
• Peripheral artery disease
• Thyroid problems

Talk With Others Who Understand

MGteam is the social network for people with myasthenia gravis and their loved ones. Members come together to ask questions, give advice, and share their stories with others who understand life with myasthenia gravis.

Are you experiencing muscle pain or muscle cramps? Share your experience and what strategies for relief work for you in the comments below, start a conversation by posting on your Activities page, or connect with like-minded members in Groups.