Back pain affects nearly 6 percent of Americans every day and leads to more physician visits than any other condition with the exception of upper respiratory infection, according to American Family Physician. Although muscle relaxants are considered a first-line treatment for the management of back pain, they have not been shown to be more effective than acetaminophen or ibuprofen. Furthermore, studies have not proven any one muscle relaxant to be more effective than any another.
Cyclobenazeprine has consistently ranked among the top 25 drugs prescribed by physicians and represents the most widely used muscle relaxant. The greatest benefit from cyclobenazeprine is noticed within the first four days of treatment, and the majority of patients demonstrate significant improvement within 14 days. Whether these findings are truly related to the effectiveness of cyclobenazeprine or to the tendency of back pain to gradually improve with time regardless of treatment remains uncertain.
Fatigue, dry mouth, and significant drowsiness are frequent side effects. Physicians often rely on the sedative properties of cyclobenazeprine to help alleviate insomnia created by painful back muscle spasms.
Methocarbamol is frequently prescribed for the treatment of muscle spasms, but studies demonstrating its superiority over other muscle relaxants are lacking. It remains an inexpensive, yet effective choice for patients who can’t tolerate the sedation associated wit cyclobenazeprine.
Approved in 2003 by the Food and Drug Administration, metaxalone has gained a greater market presence despite its lack of generic alternative. Metaxalone is generally better tolerated than other muscle relaxants and may be a better choice for patients sensitive to the fatigue, dizziness, and drowsiness common with muscle relaxers.
Other Muscle Relaxants
Diazepam (Valium), carisoprodol (Soma), orphenadrine (Norflex), and chlorzoxazone (Parafon Forte) are other muscle relaxants prescribed for the short-term treatment of muscle spasms. They are not more effective than other muscle relaxants for the treatment of back pain and do have drawbacks. As with metaxalone, drug cost and availability can be an issue. Additionally, both diazepam and carisoprodol have associated risks of physical dependence/abuse and should be used with caution.
- American Family Physician: Choosing a Skeletal Muscle Relaxant
- “The Pharmacological Basis of Therapeutics”; Goodman and Gilman; 2006
- American Family Physician: Evaluation and Treatment of Acute Low Back Pain