Muscle relaxants may be prescribed as an adjunctive treatment for acute back pain. Here are 6 important facts that you must know if you plan to take muscle relaxants 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.
The use of these drugs may also be considered controversial by some physicians. 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. 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.
Skeletal muscle relaxants are important when one considers the large number of rehabilitation patients with muscle hyperexcitability that is associated with either spasm or spasticity.
Likewise, certain rehabilitation interventions complement the actions of muscle relaxant drugs. For example, therapists often use therapeutic exercise, physical agents, and other techniques to help reduce muscle spasms and spasticity. These interventions can supplement drug effects, thus enhancing muscle relaxation and enabling the patient to engage more actively in physical rehabilitation.
You should therefore understand the actions and effects of skeletal muscle relaxants to take advantage of the synergy between drug therapy and physical interventions. The drugs discussed in this chapter decrease muscle excitability and contraction by acting at the spinal cord level, at the neuromuscular junction, or within the muscle cell itself.
Some texts also classify neuromuscular junction blockers such as curare derivatives and succinylcholine as skeletal muscle relaxants. However, these drugs are more appropriately classified as skeletal muscle paralytics because they eliminate muscle contraction by blocking transmission at the myoneural synapse.
This type of skeletal muscle paralysis is used primarily during general anesthesia see Chapter Skeletal muscle relaxants do not typically prevent muscle contraction; they only attempt to normalize muscle excitability to decrease pain and improve motor function.
Much confusion and consternation often arise from the erroneous use of the terms spasticity and spasm. For the purpose of this text, these terms will be used to describe two different types of increased excitability, which result from different underlying pathologies.
Spasticity occurs in many patients following an injury to the central nervous system CNS , including cord-related problems e. Although there is considerable controversy about the exact changes in motor control, most clinicians agree that spasticity is characterized primarily by an exaggerated muscle stretch reflex Fig.
Schematic illustration of the basic components of the stretch reflex. Normally, higher CNS centers control the sensitivity of this reflex by inhibiting synaptic connections within the spinal cord. Low-dose cyclobenzaprine versus combination therapy with ibuprofen for acute neck or back pain with muscle spasm: a randomized trial. Curr Med Res Opin. 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. 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. Carisoprodol: a marginally effective skeletal muscle relaxant with serious abuse potential. Hosp Pharm. This content is owned by the AAFP.
A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.
Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Aug 1, Issue. Choosing a Skeletal Muscle Relaxant. 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. Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue. Purchase Access: See My Options close. Best Value! To see the full article, log in or purchase access. More in Pubmed Citation Related Articles.
Email Alerts Don't miss a single issue. Sign up for the free AFP email table of contents. Navigate this Article.
Most studied skeletal muscle relaxant. Long elimination half-life. Avoid in older patients and in patients with glaucoma. Possible drug interaction with CYP inhibitors.
FDA pregnancy category B. Also an antispastic agent. Complete blood count and liver function tests indicated for prolonged use. FDA pregnancy category D; avoid especially in the first trimester. Reduced dosages in older patients. Avoid in patients with glaucoma, cardiospasm, or myasthenia gravis. FDA pregnancy category C. Also antispastic agent. Caution with CYP1A2 inhibitors, central nervous system depressants, or alcohol.
Abstract Health care providers prescribe skeletal muscle relaxants for a variety of indications. Publication types Review.
0コメント