Which treatments relieve painful muscle spasms from a black widow spider bite?
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Opioids relieve pain and benzodiazepines ease muscle spasms in most patients with latrodectism--widespread, sustained spasms--resulting from envenomation by a black widow spider (strength of recommendation [SOR]: C, case series). Black widow-specific antivenin appears to shorten duration of symptoms and reduce hospitalization more than symptomatic treatment, but can cause allergic reactions, including anaphylaxis and death from acute and delayed serum reactions (SOR: C, case series). A similar antivenin against the redback spider, a close relative of the black widow, produces clinical effects that are equivalent whether they're given intravenously (producing measurable serum levels) or intramuscularly (producing no measurable serum levels) (SOR: B, randomized controlled trial [RCT]), raising the possibility that the antivenin might not be effective at all. Calcium gluconate appears ineffective for symptom relief (SOR: C, case series).
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