6 Things to Know About Muscle Relaxants

When you have back pain, your doctor may recommend muscle relaxants—a group of drugs that are typically obtained with a doctor’s prescription. These drugs have the potential to decrease tension and spasm within a sore muscle, which may reduce pain.

Here are 6 important facts that you must know if you plan to take muscle relaxants for back pain:

1. Muscle relaxants are typically a second-line treatment for back pain

Scientific evidence and medical consensus indicate that back pain must be treated first with pain-relieving medications, such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs). If these treatments fail, doctors may prescribe skeletal muscle relaxants for a short duration. ¹ Witenko C, Moorman-Li R, Motycka C, et al. Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain. P T. 2014;39(6):427–435. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103716/ ^{, 2} Chou R, Qaseem A, Snow V, et al. Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine. 2007;147(7):478. doi: 10.7326/0003-4819-147-7-200710020-00006 Examples of prescription skeletal muscle relaxants include cyclobenzaprine and carisoprodol.

Research isn’t very robust on the use of muscle relaxants for back pain. The use of these drugs may also be considered controversial by some physicians. ¹ Witenko C, Moorman-Li R, Motycka C, et al. Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain. P T. 2014;39(6):427–435. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103716/

See Medications for Back Pain and Neck Pain

2. Acute back pain may benefit more from a muscle relaxant

While treating acute musculoskeletal back pain, a short course of muscle relaxants may be more effective when used as an adjunctive treatment in the first 3 weeks. They may also be used when back pain causes disturbed sleep (for their sedative effect). ³ Jackson KC II, Argoff CE, Dubin A. Skeletal Muscle Relaxants. In: Practical Management of Pain. Elsevier; 2014:569-574.e1. doi:10.1016/b978-0-323-08340-9.00041-4

These drugs exert their muscle-relaxing effects by inhibiting nerve signals in the brain and spinal cord and may help break the pain-spasm-pain cycle, where pain causes your muscles to spasm as a protective response, and those spasms, in turn, cause more pain. ³ Jackson KC II, Argoff CE, Dubin A. Skeletal Muscle Relaxants. In: Practical Management of Pain. Elsevier; 2014:569-574.e1. doi:10.1016/b978-0-323-08340-9.00041-4

See Common Uses for Treating Back and Neck Pain with Muscle Relaxers

3. They may be more suitable for younger adults

Skeletal muscle relaxants may cause the functions of your central nervous system (CNS) to slow down, leading to CNS depression. As a result, the drowsiness and gait disturbances caused by muscle relaxants may pose a risk of falls and subsequent injury, especially in the elderly population. ¹ Witenko C, Moorman-Li R, Motycka C, et al. Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain. P T. 2014;39(6):427–435. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103716/ ^{, 4} Spence MM, Shin PJ, Lee EA, Gibbs NE. Risk of Injury Associated with Skeletal Muscle Relaxant Use in Older Adults. Annals of Pharmacotherapy. 2013;47(7-8):993-998. doi:10.1345/aph.1r735

4. Potential side effects may occur

Several side effects are possible with the use of skeletal muscle relaxants, including but not limited to ¹ Witenko C, Moorman-Li R, Motycka C, et al. Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain. P T. 2014;39(6):427–435. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103716/ :

• Drowsiness
• Dizziness or lightheadedness
• Headache
• Fatigue
• Gait disturbances

In patients who have liver, kidney, and/or heart problems, these drugs must be avoided or used with caution. ¹ Witenko C, Moorman-Li R, Motycka C, et al. Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain. P T. 2014;39(6):427–435. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103716/

See Side Effects and Risks of Muscle Relaxers

For your safety and appropriate treatment of your condition, always discuss any changes to your medications with your doctor beforehand. Once you’ve been prescribed a muscle relaxant, be sure to tell your doctor if you notice any new signs and/or symptoms, or if your condition does not improve, as these findings may require additional medical attention.

5. Abuse and serious risks are possible

Muscle relaxants can be addictive, so it's ideal to use them for the shortest possible time and keep them away from other adults and children. Because these medications depress the central nervous system, breathing can be affected, and an overdose can be fatal.

Combining a muscle relaxant with alcohol or another medication that also has a sedating effect is especially dangerous.

6. They must be discontinued gradually

If you've been taking a muscle relaxant for an extended period, don't abruptly stop taking it one day. Doing so may set you up for some unpleasant withdrawal symptoms, such as nausea, vomiting, and trouble sleeping. When these drugs need to be discontinued, doctors typically taper the dose gradually before stopping the medicine.

It's good to keep in mind that muscle relaxants are just one part of pain control for your back problem. To keep back pain from returning, your doctor may recommend other treatments, such as physical therapy and exercise, ergonomic changes at work, and/or epidural steroid injections.

See Non-Surgical Treatments for Lower Back Pain

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