| One question that comes up repeatedly is, "Where | | | | selected over another is that a physician may have |
| do muscle relaxants fall into the treatment approach | | | | samples in his closet that he can give to a patient to |
| for different musculoskeletal conditions"? | | | | try before giving the patient a prescription. |
| Patients will sometimes ask about them and | | | | The most widely studied and used agent is |
| physicians who see these patients sometimes | | | | cyclobenzaprine. This has been shown to be |
| wonder if these drugs should be considered. | | | | effective for various musculoskeletal conditions but |
| Skeletal muscle relaxants are the most widely | | | | causes drowsiness, as does tizanidine [Zanaflex]. As a |
| prescribed drug class in the United States for | | | | result, patients with insomnia caused by muscle |
| non-specific low back pain. | | | | spasms, may find tizanidine or cyclobenzaprine to be |
| In addition, this class of drugs is used for neck pain, | | | | useful. Cyclobenzaprine is particularly helpful for many |
| muscle spasms, fibromyalgia, and myofascial pain. | | | | patients with fibromyalgia. |
| Goals for the treatment of musculoskeletal conditions | | | | All skeletal muscle relaxants have adverse effects |
| include relief of muscle pain and improvement in | | | | which include most commonly dizziness, drowsiness, |
| function and therefore, a return to normal activities | | | | and dryness of the mouth. |
| of daily living. | | | | Methocarbamol and metaxalone may be are less |
| The two primary categories of skeletal muscle | | | | sedating than tizanidine and cyclobenzaprine. |
| relaxants are anti-spastic agents (eg, baclofen | | | | However, they may also be more habituating in some |
| [Kemstro and Lioresal] or dantrolene [Dantrium]) for | | | | cases. |
| diseases like cerebral palsy, spastic torticollis, and | | | | Skeletal muscle relaxants are generally not considered |
| multiple sclerosis and anti-spasmodic agents for | | | | first-line therapy for musculoskeletal conditions. Most |
| muscle-related conditions. | | | | physicians will start with acetaminophen (Tylenol) or |
| Anti-spastic agents are rarely used for | | | | non-steroidal-anti-inflammatory drugs (NSAIDS) first. |
| musculoskeletal conditions; however, some | | | | Many clinical trials have supported the notion that |
| rheumatologists report success in treating | | | | NSAIDS are superior to muscle relaxants in patients |
| fibromyalgia using baclofen. Since this is an "off-label" | | | | suffering from acute low back pain. However, it is |
| use, caution should be exerted and the lowest | | | | also known from the data that muscle relaxants are |
| possible doses should be prescribed... and then only | | | | superior to placebo. |
| by specialists who have much experience. Patients | | | | For acute low back pain syndromes, skeletal muscle |
| should be informed as to the potential side effects. | | | | relaxants may be used as additional therapy to |
| Antispasmodic agents are much more widely used | | | | NSAIDS. |
| for musculoskeletal conditions. | | | | For acute low back pain, muscle relaxants should be |
| The most often prescribed antispasmodic agents are | | | | used short term (2 weeks). Some patients with |
| carisoprodol [Soma}, cyclobenzaprine (Flexeril), | | | | chronic back conditions as well as patients with |
| metaxalone (Skelaxin), and methocarbamol (Robaxin). | | | | fibromyalgia may require chronic long-term use of |
| In terms of effectiveness, there appears to be no | | | | muscle relaxants. |
| one muscle relaxant that is superior to another. | | | | Muscle relaxants should be avoided in frail elderly |
| Often, physicians will prescribe the muscle relaxant | | | | patients because of the danger related to sedation |
| they are most familiar with. Another reason one is | | | | and falling. |