Treatment of fibromyalgia with cyclobenzaprine: a meta-analysis. Arthritis Rheum. Carville SF, Arendt-Nielsen S, Bliddal H, et al.

EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis. Luo X, Pietrobon R, Curtis LH, Hey LA. Prescription of nonsteroidal anti-inflammatory drugs and muscle relaxants for back pain in the United States.

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low back pain. Cochrane Database Syst Rev. 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.

Diamond S. Double-blind study of metaxalone; use as a skeletal-muscle relaxant. Chou R, Huffman LH. Arbus L, Fajadet B, Aubert D, Morre M, Goldfinger E. Activity of tetrazepam in low back pain. Clin Trials J. Salzmann E, Pforringer W, Paal G, Gierend M. Treatment of chronic low-back syndrome with tetrazepam in a placebo controlled double-blind trial.

J Drug Dev. Scheiner JJ. Cyclobenzaprine in the treatment of local muscle spasm. Minneapolis, Minn. Aiken DW.

A comparative study of the effects of cyclobenzaprine, diazepam, and placebo on acute skeletal muscle spasm of local origin. Brown BR, Womble J. Cyclobenzaprine in intractable pain syndrome with muscle spasms.

Basmajian JV. Cyclobenzaprine hydrochloride effect on skeletal muscle spasm in the lumbar region and neck: two double-blind controlled clinical laboratory studies. Arch Phys Med Rehabil. Browning R, Jackson JL, O'Malley PG.

Cyclobenzaprine and back pain: a meta-analysis. Arch Intern Med. Borenstein DG, Lacks S, Wiesel SW. Cyclobenzaprine and naproxen versus naproxen alone in the treatment of acute low back pain and muscle spasm.

Clin Ther. Childers MK, Borenstein D, Brown RL, et al. Low-dose cyclobenzaprine versus combination therapy with ibuprofen for acute neck or back pain with muscle spasm: a randomized trial. Curr Med Res Opin.

Boyles W, Glassman J, Soyka J. Management of acute musculoskeletal conditions: thoracolumbar strain or sprain. Double-blind evaluation comparing the efficacy and safety of carisoprodol with diazepam.

Today's Ther Trends. Bragstad A, Blikra G. Evaluation of a new skeletal muscle relaxant in the treatment of lower back pain a comparison of DS — with chlorzoxazone. Curr Ther Res Clin Exp. Beebe FA, Barkin RL, Barkin S. A clinical and pharmacologic review of skeletal muscle relaxants for musculoskeletal conditions.

Am J Ther. Borenstein DG, Korn S. Efficacy of a low-dose regimen of cyclobenzaprine hydrochloride in acute skeletal muscle spasm: results of two placebo-controlled trials.

Boothby LA, Doering PL, Hatton RC. Carisoprodol: a marginally effective skeletal muscle relaxant with serious abuse potential. Hosp Pharm.

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search close. PREV Aug 1, NEXT. C 12 , 13 , 15 Skeletal muscle relaxants may be used as adjunctive therapy for acute low back pain. B 17 , 18 Antispasmodic agents should be used short-term two weeks for acute low back pain.

C 17 , 18 There is no clear evidence that one skeletal muscle relaxant is superior to another for musculoskeletal spasms. B 17 , 18 Choice of skeletal muscle relaxant should be based on individual drug characteristics and patient situation.

All of these drugs may cause increased drowsiness with central nervous system depressants. Evidence of Effectiveness. BACK AND NECK PAIN. Place in Therapy. SHARON SEE, PharmD, BCPS, is an associate clinical professor at St. John's University College of Pharmacy and Allied Health Professions in Jamaica, NY, and a faculty member at the Beth Israel Residency Program in Urban Family Practice in New York, NY.

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. John's University College of Pharmacy and Allied Health Professions and a faculty member at the Beth Israel Residency Program in Urban Family Practice.

She received her doctor of pharmacy degree from St. John's University College of Pharmacy and Allied Health Professions, and completed a general practice residency at Albert Einstein Medical Center in Philadelphia, Pa.

Continue Reading. More in AFP. More in Pubmed. Copyright © by the American Academy of Family Physicians. Copyright © American Academy of Family Physicians. All Rights Reserved. Skeletal muscle relaxants are not considered first-line therapy for musculoskeletal conditions.

Skeletal muscle relaxants may be used as adjunctive therapy for acute low back pain. Antispasmodic agents should be used short-term two weeks for acute low back pain.

There is no clear evidence that one skeletal muscle relaxant is superior to another for musculoskeletal spasms. Choice of skeletal muscle relaxant should be based on individual drug characteristics and patient situation.

Dizziness, drowsiness, headache Rare idiosyncratic reactions mental status changes, transient quadriplegia, and temporary loss of vision after first dose; may require hospitalization Allergy-type reactions may occur after the first to fourth dose; may be mild e.

Intravenous muscle relaxers are reserved for use in a hospital or other clinical setting. The intrathecal route involves delivering medication directly into the fluid surrounding the spinal cord, typically through an implanted pain pump.

Intrathecal muscle relaxers are generally only used in cases of severe spasticity from an underlying chronic condition such as cerebral palsy. The following table lists the commonly prescribed muscle relaxers, the types of muscle issues they treat, and the mode of delivery.

Antispasmodic muscle relaxers are more frequently prescribed for back and neck pain compared to antispastics. Muscle relaxers are prescribed when muscle spasms or spasticity are suspected as the cause of the pain, such as in cases of 1 Barreto TW, Lin KW. html :. The effectiveness of muscle relaxers differs for each person.

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. Muscle relaxers are generally safe and well-tolerated when used short-term at recommended doses.

Sedation and drowsiness are the most commonly reported side effects, but factors such as underlying conditions and the use of other medications may increase the risk. Package Insert. Advagen Pharma Limited; - 18 Orphenadrine. Amneal Pharmaceuticals of New York LLC; Next Page: Side Effects and Risks of Muscle Relaxers.

Kathee de Falla is a licensed and certified pharmacist. She has more than a decade of experience providing medical advice and supplying prescription medications in a retail setting. de Falla spent several years developing drugs at Abbott Laboratories, a pharmaceutical company where she holds a patent for a drug formulation.

Home Treatment Pain Medication Muscle Relaxants: List of Common Muscle Relaxers. Muscle Relaxants: List of Common Muscle Relaxers. By: Kathee de Falla, PharmD, Pharmacist Peer-Reviewed.

html Muscle relaxers are the third most prescribed medication for low back pain. Show Transcript. In This Article: Muscle Relaxants: List of Common Muscle Relaxers Side Effects and Risks of Muscle Relaxers Common Uses for Treating Back and Neck Pain with Muscle Relaxers Medications for Back Pain Video.

When Muscle Relaxers are Prescribed. Your user agent does not support the HTML5 Video element. Illustration showing posterior view of the skull with red highlights around the neck.

Muscle relaxants alleviate pain by reducing muscle spasms and tensions. html The decision to prescribe a muscle relaxer is based on the following factors: When over-the-counter OTC and non-drug therapies eg, physical therapy , stretching , or heat therapy are ineffective 1 Barreto TW, Lin KW.

html In addition to OTC pain medication, rest, physical therapy, and other non-drug therapies to relieve discomfort and improve function 3 Conermann T, Christian D.

Types of Prescription Muscle Relaxers Muscle relaxers are categorized based on their ability to treat stiffness, spasms, or both. Antispastic drugs. These medications reduce tightness in the muscle through various mechanisms in the brain and directly within the muscle tissue.

These medications stop the spontaneous or involuntary contraction of muscles such as jerks, twitches, or cramps that cause spasms.

Common Muscle Relaxers and Their Effects The following table lists the commonly prescribed muscle relaxers, the types of muscle issues they treat, and the mode of delivery. Medication Antispastic Antispasmodic Mode of Delivery 8 Drugs FDA: FDA-Approved Drugs. gov Baclofen Lioresal 9 Baclofen.

Granules Pharmaceuticals Inc. When Muscle Relaxers May Be Prescribed for Back and Neck Pain. A short video showing a torn ligament. Muscle strain or ligament sprain is a common indication for muscle relaxants. html : Injury or trauma Muscle strain Poor posture Spinal conditions eg, scoliosis Neurological conditions eg, multiple sclerosis and cerebral palsy Nerve inflammation or compression sciatica The effectiveness of muscle relaxers differs for each person.

n Safety Profile of Muscle Relaxers Muscle relaxers are generally safe and well-tolerated when used short-term at recommended doses. n Sedation and drowsiness are the most commonly reported side effects, but factors such as underlying conditions and the use of other medications may increase the risk.

Amneal Pharmaceuticals of New York LLC; It is advisable to discuss the potential side effects and risks with a doctor. References 1 Barreto TW, Lin KW. html 2 Cashin AG, Folly T, Bagg MK, et al. doi: n 3 Conermann T, Christian D.

gov 9 Baclofen. Advagen Pharma Limited; 10 Dantrolene. Amneal Pharmaceuticals of New York LLC; 11 Tizanidine. Advagen Pharma Limited; 12 Diazepam. Mayne Pharma Commercial LLC; 13 Soma. Meda Pharmaceuticals Inc; 14 Chlorzoxazone. Aurobindo Pharma Limited; 15 Cyclobenzaprine. Rising Health, LLC; 16 Metaxalone.

Smooth muscle relaxants tend to have fewer side effects so will often be suggested first. Some people seem to respond better to one type of antispasmodic than to another, so if one type does not work for you, it may be worth trying another. Some types of antispasmodics are available over-the-counter without a prescription.

However, you should always speak to your IBD team before taking one of these medicines, in case it is not suitable for you, or might interact with other medicines you are taking. If you are prescribed antispasmodics, your IBD team or doctor will tell you how to take the medicine. You can also read the patient information leaflet that comes with them.

You may be encouraged to take antispasmodics at specific times of day, in relation to when your symptoms occur. It is generally recommended that you only take antispasmodics when necessary, stopping if the symptoms settle down. Most people who take antispasmodics will not have any serious side effects.

Generally smooth muscle relaxant antispasmodics will have fewer, milder side effects than antimuscarinics. This is because antimuscarinics block the chemical messenger acetylcholine, which has other roles within the body, including dilating blood vessels, increasing bodily secretions and slowing your heart rate.

You can read the accompanying patient information leaflet for medicine-specific side effects and cautions. Most people can take antispasmodics safely, however there are a few exceptions. This will be listed in the patient information leaflets, and includes:.

Why not sign up to our mailing list and receive regular articles and tips about IBD to your inbox. Why not sign up to our mailing list and receive regular articles and tips about IBD to your inbox?

Home Learn Treatment Medication for IBD Antispasmodics and IBD. Related links Medication for IBD Over the counter medication. What are antispasmodics? The goals of treatment include managing muscle pain and improving functional status so the patient can return to work or resume previous activities.

Skeletal muscle relaxants are divided into two categories: antispastic for conditions such as cerebral palsy and multiple sclerosis and antispasmodic agents for musculoskeletal conditions. Antispastic agents e. Rather, an antispasmodic agent may be more appropriate Table 1.

Among antispasmodic agents, carisoprodol Soma , cyclobenzaprine Flexeril , metaxalone Skelaxin , and methocarbamol Robaxin were among the top drugs dispensed in the United States in The American Pain Society and the American College of Physicians recommend using acetaminophen and nonsteroidal anti-inflammatory drugs NSAIDs as first-line agents for acute low back pain and reserving skeletal muscle relaxants as an alternative treatment option.

Similar recommendations exist in treating tension headaches. Prescription rates for nonspecific back pain revealed that skeletal muscle relaxants accounted for This article presents evidence regarding the use of antispasmodic skeletal muscle relaxants for various musculoskeletal conditions, and appropriate drug selection if a skeletal muscle relaxant is required.

Highlights of contraindications, adverse effects, and drug interactions for these drugs are listed in Table 1. Many of the studies evaluating the effectiveness of skeletal muscle relaxants are hampered by poor methodologic design, including incomplete reporting of compliance, improper or no mention of allocation concealment, not utilizing intention-to-treat methods, and inadequate randomization.

Some evidence appears to support nonbenzodiazepine skeletal muscle relaxants, such as carisoprodol, cyclobenzaprine, orphenadrine Norflex , and tizanidine Zanaflex , for acute low back pain.

One fair-quality study showed no difference between metaxalone and placebo. 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.

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]. Eatontown, NJ: West-ward Pharmaceutical Corp. 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. While antispasmodics can be used to treat muscle spasms, they have not been shown to work better than nonsteroidal anti-inflammatory drugs NSAIDs or acetaminophen.

In addition, they have more side effects than NSAIDs or acetaminophen. You should talk to your doctor about the benefits and risks of these medications for the treatment of your muscle spasms. On March 21, , Sandoz issued a voluntary recall of 13 lots of the drug orphenadrine citrate mg ER tablets due to the presence of nitrosamine.

Nitrosamine, a known carcinogen with the potential to cause cancer, was found to exist in the drug at levels greater than the acceptable daily intake ADI as determined by the FDA.

This recall is specific only to a handful of lot numbers and does not affect all orphenadrine tablets made by Sandoz. If you take orphenadrine citrate mg ER tablets, talk with your pharmacist or doctor and they will help you determine if your medication has been impacted by the recall. Antispastics are used to treat muscle spasticity.

They should not be used to treat muscle spasms. These drugs include the following:. Baclofen Lioresal is a skeletal muscle relaxer used to relieve spasticity caused by MS. Side effects can include drowsiness, dizziness, weakness, and fatigue. Dantrolene Dantrium is a skeletal muscle relaxer used to treat muscle spasms caused by spinal cord injury , stroke, cerebral palsy, or MS.

It works by acting directly on the skeletal muscle to relax the muscle spasm. Side effects can include drowsiness, dizziness, lightheadedness , and fatigue. Diazepam Valium is a benzodiazepine used to relieve muscle spasms caused by inflammation, trauma, or muscle spasticity. It works by increasing the activity of a certain neurotransmitter to decrease the occurrence of muscle spasms.

Diazepam is a sedative. Side effects can include drowsiness, fatigue , and muscle weakness. Muscle relaxants such as carisoprodol and diazepam can be habit-forming. Be sure to take your medication exactly as prescribed by your doctor.

Also, muscle relaxants depress your central nervous system CNS , making it hard to pay attention or stay awake. While taking a muscle relaxant, avoid activities that require mental alertness or coordination, such as driving or using heavy machinery.

Doctors can use certain medications to treat spasticity even when the drugs are not approved for that purpose by the U. Food and Drug Association FDA.

This is called off-label drug use. The following drugs are not actually muscle relaxants, but they can still help relieve symptoms of spasticity. Benzodiazepines are sedatives that can help relax muscles.

They work by increasing the effects of certain neurotransmitters, which are chemicals that relay messages between your brain cells.

Side effects of benzodiazepines can include drowsiness and problems with balance and memory. These drugs can also be habit-forming. Gabapentin Neurontin is an anticonvulsant drug typically used to relieve seizures. It may also help prevent pain responses associated with spasticity. Gabapentin is available in brand-name and generic versions.

OTC treatment is recommended as first-line therapy for muscle spasms caused by conditions such as acute lower back pain or tension headache. This means you should try OTC treatments before prescription medications. OTC treatment options include nonsteroidal anti-inflammatory drugs NSAIDs , acetaminophen, or a combination of both.

Your doctor or pharmacist can help you choose an OTC treatment. NSAIDs work by blocking your body from making certain substances that cause inflammation and pain. NSAIDs are available in generic and brand-name versions. Stronger versions are available by prescription. NSAIDs come as oral tablets, capsules, or suspensions.

They also come as chewable tablets for children. Side effects of these drugs can include upset stomach and dizziness. Acetaminophen Tylenol is thought to work by blocking your body from making certain substances that cause pain. Acetaminophen is available in generic and brand-name versions.

It comes as immediate-release and extended release oral tablets and capsules, orally disintegrating tablets, chewable tablets, and oral solutions. The more common side effects of acetaminophen can include nausea and upset stomach. Studies show that certain compounds in cannabis could act as a muscle relaxant, including tetrahydrocannabinol THC , the substance responsible for the psychoactive effects of marijuana.