It may be necessary to try an alternative if the initial prescription is not effective. Many drugs interact with muscle relaxers and a person should keep their health care provider informed of all prescription and non-prescription medications he or she is taking. Medication is just one part of pain relief. These medications are intended to be one element, usually on a short-term basis, of an overall recovery strategy that includes rest, stretching, physical therapy, and other exercise.
See Exercise and Back Pain. Stiff Neck Causes, Symptoms, and Treatment. Medications for Back Pain and Neck Pain. Physical Therapy for Neck Pain Relief. You are here Treatment Pain Medication. Cyclobenzaprine has been the most heavily studied drug, with consistently proven effectiveness.
Cyclobenzaprine was found to be moderately more effective than placebo, but had more central nervous system adverse effects. The authors also described several limitations of the meta-analysis including inadequate blinding, heterogeneity among studies, and the presence of publication bias.
Skeletal muscle relaxants have also been studied as adjunctive therapy to analgesics in treating acute low back pain. In one open-label study 20 patients , the addition of cyclobenzaprine to naproxen Naprosyn resulted in a statistically significant decrease in muscle spasm and tenderness compared with naproxen alone.
Cyclobenzaprine has also been studied in treating fibromyalgia. A meta-analysis of five trials ranging from six to 24 weeks' duration included a total of patients with fibromyalgia. The authors reported that, although cyclobenzaprine moderately improved sleep and pain, the long-term benefits were unknown.
This meta-analysis was limited by a high drop-out rate, short trial duration, few studies having an intention-to-treat design, and inadequate blinding. Strong data comparing skeletal muscle relaxants to each other are scarce.
A systematic review evaluated 46 trials head-to-head and placebo-controlled comprising mostly of studies on low back pain or neck syndromes. The placebo-controlled trials included 17 on cyclobenzaprine, six on tizanidine, four on carisoprodol, and four on orphenadrine, and were mostly conducted more than 15 years ago.
The average patient enrollment was less than patients range 12 to patients. In general, all of the drugs were shown to have some benefit. One fair-quality study showed carisoprodol was better than diazepam at improving muscle spasm and global and functional status in patients with low back pain.
A different systematic review did include some studies which were considered to be high quality. Although the evidence for effectiveness of skeletal muscle relaxants in musculoskeletal conditions is limited, strong evidence does exist in terms of toxicity.
Selection of a skeletal muscle relaxant should be individualized to the patient. If there are tender spots over the muscle or trigger points on physical examination, a skeletal muscle relaxant is a reasonable adjunct to analgesic treatment of low back pain. Skeletal muscle relaxants may also be used as an alternative to NSAIDs in patients who are at risk of gastrointestinal or renal complications. Patients with low back pain or fibromyalgia may benefit from treatment with cyclobenzaprine.
Recent evidence showed similar effectiveness at half of its manufacturer recommended dose 5 mg , but with fewer adverse effects. Higher doses of cyclobenzaprine or tizanidine would be appropriate to promote sedation in cases of more severe discomfort or perceived muscular spasm. Although there appears to be insufficient data on metaxalone and methocarbamol, these may be useful in patients who cannot tolerate the sedative properties of cyclobenzaprine or tizanidine.
Of note, methocarbamol costs substantially less than metaxalone. Carisoprodol is metabolized to meprobamate a class III controlled substance and has been shown to produce psychological and physical dependence. Although all skeletal muscle relaxants should be used with caution in older patients, diazepam especially should be avoided in older patients or in patients with significant cognitive or hepatic impairment.
Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. She received her doctor of pharmacy degree from Rutgers University College of Pharmacy in New Brunswick, NJ, and completed an inpatient family medicine pharmacy specialty residency at Deaconess Hospital and the St. Louis College of Pharmacy in St. Louis, Mo. She received her doctor of pharmacy degree from St. Reprints are not available from the authors. Carisoprodol carisoprodol tablet [package insert].
Philadelphia, Pa. Accessed January 14, Chlorzoxazone chlorzoxazone tablet [package insert]. Sellersville, Pa. Cyclobenzaprine hydrochloride cyclobenzaprine hydrochloride tablet [package insert]. Corona, Calif. Diazepam diazepam tablet [package insert]. Miami, Fla. Skelaxin metaxalone [package insert]. Briston, Tenn. Methocarbamol methocarbamol tablet [package insert]. January 14, Orphenadrine citrate extended-release orphenadrine citrate tablet [package insert].
Princeton, NJ: Sandoz, Inc. Tizanidine hydrochloride tizanidine hydrochloride tablet [package insert]. Pomona, NY: Barr Laboratories. United States Food and Drug Administration. Zanaflex tizanidine hydrochloride tablets and capsules. Top brand-name drugs by units in Top generic drugs by units in Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society [published correction appears in Ann Intern Med.
Ann Intern Med. National Headache Foundation. National Headache Foundation standards of care for headache diagnosis and treatment. Chicago, Ill. Treatment of fibromyalgia with cyclobenzaprine: a meta-analysis. Arthritis Rheum. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis. Prescription of nonsteroidal anti-inflammatory drugs and muscle relaxants for back pain in the United States. Muscle relaxants for non-specific low back pain.
Cochrane Database Syst Rev. Below, we describe the different types, recommended dosages for adults, and possible side effects. We also look into an over-the-counter OTC option and whether cannabis might help. Muscle relaxers encompass two classes of medications: antispasmodics and antispastics. Antispastics directly affect the spinal cord or the skeletal muscles with the aim of improving muscle tightness and spasms.
Antispasmodics help reduce muscle spasms via the central nervous system. They inhibit the transmission of neurons in the brain. Antispastics and antispasmodics have different indications and side effects. Since these drugs work differently, a person should never use them interchangeably or substitute one type for another.
While muscle relaxants may provide short-term relief of acute lower back pain and muscle spasms, these medications can cause adverse side effects. Some muscle relaxers can also be addictive. Also, doctors and pharmacists may warn against using certain medications or consuming alcohol with muscle relaxers, as the interactions can be dangerous.
These muscle relaxers alter the conduction in the central nervous system to decrease muscle spasms. Benzodiazepines block certain chemicals in the brain, and nonbenzodiazepines act on both the brain and spinal cord. Diazepam is a benzodiazepine. Doctors may prescribe diazepam for severe muscle spasms and for spasticity associated with neurological disorders.
Valium and Diastat are common brand names of this drug in the United States. DailyMed , an extension of the National Institutes of Health NIH , report the dosage as 2—10 milligrams mg orally three or four times a day. If someone requires diazepam injections, the doctor may prescribe an initial intravenous IV dose of 5—10 mg and another dose 3—4 hours later. Common side effects of diazepam include:. There is a risk of severe drowsiness or sedation if a person takes this medication and an opioid.
Other risks of combining a benzodiazepine with an opioid include respiratory failure, coma , and death. Carisoprodol is a nonbenzodiazepine. Adults can take carisoprodol for the relief of acute, painful muscle conditions. A common brand name for this drug in the U. Doctors can only prescribe it for a maximum of 3 weeks.
There is insufficient evidence that it works for longer periods. The recommended dosage is — mg three times a day and at bedtime. The most common side effects of carisoprodol include:.
Doctors also warn people of the dangers of combining this medication with alcohol. In addition, there is a risk of developing a dependency on carisoprodol. Cyclobenzaprine is a nonbenzodiazepine. It can treat muscle spasms that occur with acute muscle conditions when a person combines it with rest and physical therapy. Flexeril, Amrix, and Fexmid are brand names of this drug in the U. Cyclobenzaprine comes in two oral forms: immediate-release tablets and extended-release capsules.
DailyMed report that doctors usually prescribe 5 mg three times a day. However, some people require higher dosages, such as 7. The maximum is 30 mg per day. The most common side effects of cyclobenzaprine include:.
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