Prescription Muscle Relaxants

Types of muscle relaxants

Skeletal muscle relaxants are a group of different medications that each has an overall sedative effect on the body. The drugs act in the central nervous system (CNS) to produce their muscle relaxing effects.

These medications are prescribed for a variety of musculoskeletal conditions:

• back pain
• neck pain
• sciatica
• spastic conditions
• fibromyalgia
• myofascial pain syndrome

There are two types of muscle relaxers: antispasticity and antispasmodic drugs.

The antispasticity medications help to improve muscle hypertonicity and involuntary jerks. These drugs alleviate spasticity by attempting to increase reflexes.

• baclofen
• tizanidine
• dantrolene
• diazepam

Antispasmodic muscle relaxants are mainly used to treat musculoskeletal conditions such as back pain, herniated disks, sciatica, and spinal stenosis.

• carisoprodol
• cyclobenzaprine
• metaxalone
• chlorzoxazone
• methocarbamol
• tizanidine
• orphenadrine
• benzodiazepines

Back pain treatment

It is estimated that up to 91% of physicians report using muscle relaxants, and approximately 35% of patients visiting a primary care physician with the complaints of low back pain have them prescribed5.

Carisoprodol, cyclobenzaprine, orphenadrine, and tizanidine are moderately effective for short-term relief (two weeks) of acute low back pain1,2. For acute low back pain, muscle relaxers can improve pain, muscle tension, and range of motion. Skeletal muscle relaxants may provide additional improvement when used with NSAIDs.

There is also some evidence that muscle relaxers can provide relief for those with chronic low back pain. However, the incidence of drowsiness, dizziness and other sedative side effects is high.

Fibromyalgia treatment

Although not FDA approved for long term use, cyclobenzaprine is often prescribed nightly for the treatment of fibromyalgia. Cyclobenzaprine may improve sleep, alleviate pain, and increase the sense of well-being. For use in treating fibromyalgia, the usual starting dosage is 5 to 10 mg at bedtime.

The combination of carisoprodol, acetaminophen and caffeine is also used "off-label" for fibromyalgia. It can relieve pain, improve sleep, and reduce the general feeling of being sick3. Carisoprodol produces its muscle relaxant effect at the spinal cord level.

Orphenadrine is a centrally acting analgesic muscle relaxant. It is used as an adjunct to rest, physical therapy and symptomatic measures for acute musculoskeletal pain. In one clinical study4 of 85 fibromyalgia patients, over a one-year period a significant, sustained improvement in general pain was noted in 34% of participants taking orphenadrine citrate (vs. 15% and 10% of patients taking amitriptyline and cyclobenzaprine, respectively).

References

• 1. van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low back pain. Cochrane Database Syst Rev. 2003;(2):CD004252.
• 2. Chou R, Peterson K, Helfand M. Comparative efficacy and safety of skeletal muscle relaxants for spasticity and musculoskeletal conditions: a systematic review. J Pain Symptom Manage. 2004;28(2):140-175
• 3. Vaeroy H, Abrahamsen A, Forre O, Kass E. Treatment of fibromyalgia (fibrositis syndrome): a parallel double blind trial with carisoprodol, paracetamol and caffeine (Somadril comp) versus placebo. Clin Rheumatol. 1989 Jun;8(2):245-50.
• 4. Abeles M. Long Term Effectiveness of Orphenadrine Citrate in the Treatment of Fibromyalgia (Abstract). American College of Rheumatology, Scientific Abstracts: 113-A270.
• 5. Cherkin DC, Wheeler KJ, Barlow W, et al. Medication use for low back pain in primary care. Spine 1998;23(5):607–14.

Written for HealthyStock.net, October 2009.