The useful distinction on Muscle cramps is between what was measured and what was inferred from it. Both end up in the same sentence and only one of them has error bars.
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Practice · Side effects · continued
Muscle cramps: the ordinary causes before the exotic ones — a second dataset posts 61–78
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1 · go to the accepted answer.
f.yildiz, post #39: The bit of Muscle cramps that nobody enjoys is that the answer changes depending on what you are trying to decide with it. Say what the decision is and the thread will converge. Go to post
Picking up post #62: that is the part I would want checked first.
Nausea: the most common side effect and the most dose- and titration-dependent one. It is usually most prominent in the first 24 to 48 hours after injection and attenuates as the dose is held stable. At each escalation step it often resets briefly before attenuating again.
On post #60 — agreed on the reasoning, with one qualification.
Delayed gastric emptying: the mechanism behind much of the gastrointestinal side-effect profile. At extreme magnitudes, severe gastroparesis is a rare but serious complication. Distinguishing ordinary gastrointestinal effects from the rare severe end is a clinical judgement.
If anyone can point at the primary source I would be grateful.
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Collapsed as off-topic by two members at trust level 3 or above
Where I part company with post #64, and it is a narrow parting.
Two claims get bundled together under Muscle cramps and they need separating. The descriptive one — this is what was observed — is usually well supported. The causal one — this is why — usually is not.
Almost every disagreement in threads like this one dissolves once you say which of the two you are making.
Adding the measurement that post #65 says would settle it.
I changed my mind about Muscle cramps after someone here asked me for the source and I could not produce one. That is worth saying out loud because it is the ordinary way it happens.
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p.onwuka, post #64: On post #60 — agreed on the reasoning, with one qualification. Delayed gastric emptying: the mechanism behind much of the gastrointestinal side-effect profile. At extreme magnitudes, severe gastroparesis is a rare but serious complication. Distinguishing ordinary gastrointestinal effects from the rare severe end is a clinical judgement.… Go to post
Understood, and I withdraw the assumption I opened with.
Building on post #67 rather than restating it.
The relationship between symptom burden and outcome is not what people assume. Feeling worse is not evidence of a larger effect and feeling nothing is not evidence of an inactive preparation.
I have written this out at length because the short version keeps being misread.
1 like 5d
j.baptista, post #6: Post #3 describes the usual case. This is about the unusual one. Reported effects on taste and on food preference are common and interesting and unstudied in any detail. They are also the ones people find most disconcerting. Go to post
Post #69 put the caveat in the right place and I want to underline it.
Severe, persistent abdominal pain, especially radiating to the back, is in a different category from ordinary gastrointestinal upset and is a reason to seek medical assessment rather than to post about it.
Not a conclusion. A place to stand while looking for one.
h.ramos, post #42: A note on how Muscle cramps gets discussed rather than on Muscle cramps itself: the confident posts get the replies and the careful ones get ignored, and the careful ones have been right more often. Go to post
Muscle cramps is a good example of a question where the honest answer is boring and the interesting answers are unsupported. I would go with boring.
I have been on both sides of the Muscle cramps argument in this category within eighteen months, which should tell you how strong the evidence for either side is.
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d.petrescu, post #3: Muscle cramps is worth one more sentence than it usually gets, and the sentence is the one about how the number was arrived at. Go to post
Agreed, and I will stop repeating the version of this I had been repeating.
This follows post #71 rather than contradicting it.
The relationship between symptom burden and outcome is not what people assume. Feeling worse is not evidence of a larger effect and feeling nothing is not evidence of an inactive preparation.
Happy to expand any of that if it is the useful part.
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Collapsed as off-topic by two members at trust level 3 or above
Coming back to post #71, because the follow-up matters more than the original answer.
The published rates come from populations that were titrated on a defined schedule with clinical supervision. Rates from a forum are not comparable and are biased by who chooses to post.
On Muscle cramps, I would rather understate and be corrected upward than overstate and be quoted. That is a house style here and it is a good one.
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The number people quote for Muscle cramps is a central estimate presented without its interval, and the interval is wide enough that the estimate is nearly uninformative on its own.
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This topic was referenced in
- A side-effect grading scheme this community uses, and its limits — the long versionPractice › Side effects · 23 replies
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