Posts Tagged ‘Low Back Pain’

Doctor, When Should Muscle Relaxants be Used For Arthritis?

August 23rd, 2011
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Nathan Wei asked:




One question that comes up repeatedly is, “Where do muscle relaxants fall into the treatment approach for different musculoskeletal conditions”?

Patients will sometimes ask about them and physicians who see these patients sometimes wonder if these drugs should be considered.

Skeletal muscle relaxants are the most widely prescribed drug class in the United States for non-specific low back pain.

In addition, this class of drugs is used for neck pain, muscle spasms, fibromyalgia, and myofascial pain.

Goals for the treatment of musculoskeletal conditions include relief of muscle pain and improvement in function and therefore, a return to normal activities of daily living.

The two primary categories of skeletal muscle relaxants are anti-spastic agents (eg, baclofen [Kemstro and Lioresal] or dantrolene [Dantrium]) for diseases like cerebral palsy, spastic torticollis, and multiple sclerosis and anti-spasmodic agents for muscle-related conditions.

Anti-spastic agents are rarely used for musculoskeletal conditions; however, some rheumatologists report success in treating fibromyalgia using baclofen. Since this is an “off-label” use, caution should be exerted and the lowest possible doses should be prescribed… and then only by specialists who have much experience. Patients should be informed as to the potential side effects.

Antispasmodic agents are much more widely used for musculoskeletal conditions.

The most often prescribed antispasmodic agents are carisoprodol [Soma}, cyclobenzaprine (Flexeril), metaxalone (Skelaxin), and methocarbamol (Robaxin). In terms of effectiveness, there appears to be no one muscle relaxant that is superior to another. Often, physicians will prescribe the muscle relaxant they are most familiar with. Another reason one is selected over another is that a physician may have samples in his closet that he can give to a patient to try before giving the patient a prescription.

The most widely studied and used agent is cyclobenzaprine. This has been shown to be effective for various musculoskeletal conditions but causes drowsiness, as does tizanidine [Zanaflex]. As a result, patients with insomnia caused by muscle spasms, may find tizanidine or cyclobenzaprine to be useful. Cyclobenzaprine is particularly helpful for many patients with fibromyalgia.

All skeletal muscle relaxants have adverse effects which include most commonly dizziness, drowsiness, and dryness of the mouth.

Methocarbamol and metaxalone may be are less sedating than tizanidine and cyclobenzaprine. However, they may also be more habituating in some cases.

Skeletal muscle relaxants are generally not considered first-line therapy for musculoskeletal conditions. Most physicians will start with acetaminophen (Tylenol) or non-steroidal-anti-inflammatory drugs (NSAIDS) first. Many clinical trials have supported the notion that NSAIDS are superior to muscle relaxants in patients suffering from acute low back pain. However, it is also known from the data that muscle relaxants are superior to placebo.

For acute low back pain syndromes, skeletal muscle relaxants may be used as additional therapy to NSAIDS.

For acute low back pain, muscle relaxants should be used short term (2 weeks). Some patients with chronic back conditions as well as patients with fibromyalgia may require chronic long-term use of muscle relaxants.

Muscle relaxants should be avoided in frail elderly patients because of the danger related to sedation and falling.



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What Are Muscle Relaxants?

March 12th, 2011
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Steve Marshal Caldwell asked:




Muscle relaxants are the type of medicines that are used to relax the muscles that are strained due to the excessive physical pressure. Muscle relaxants help relax muscles, ease pain, and reduce stiffness. Muscle relaxants are often prescribed in the treatment of acute low back pain in an attempt to improve the initial limitations in range of motion from muscle spasm and to interrupt the pain-spasm-pain cycle. Limiting muscle spasm and improving range of motion will prepare the patient for therapeutic exercise.

Muscle relaxants are usually prescribed along with rest, exercise, physical therapy, or other treatments. Strains, sprains, and other muscle injuries can result in pain, stiffness, and muscle spasms. Muscle relaxants do not heal the injuries, but they do relax muscles and help ease discomfort and stop muscle spasms. Muscle relaxants are not really a class of drugs, but rather a group of different drugs that each has an overall sedative effect on the body. These drugs do not act directly on the muscles; rather they act centrally (in the brain) and are more of a total body relaxant.

The muscle relaxants were first found in 16th century by the German to treat there soldiers who were suffering with muscle injuries. This muscle relaxant was used to give the fast relief from the muscle injuries and use to allow the soldiers to go and fight the enemy in the short span of time. But, the first neuromuscular drug got established in 1943 that was used as the anesthesia during the surgery.  Curare was the first muscle relaxant used to treat the muscle injuries. Muscle relaxants soon became the favorite choice of the customers as they were very fast in giving the relief from the muscle injuries. Muscle relaxants are found to very effective in treating the muscle sprains, strains, and injuries.

Muscle relaxants work by affecting skeletal muscle function and decreasing the muscle tone. Muscle relaxant functions as neuromuscular blockers at several sites, including the central nervous system, myelinated somatic nerves, unmyelinated motor nerve terminals, nicotinic acetylcholine receptors, the motor end plate, and the muscle membrane or contractile apparatus. Thus, we can conclude that muscle relaxants works basically by acting on the central nervous system as they affect cortex, brain stem or spinal cord. Muscle relaxants work quite well for relieving muscle pain due to injuries, but are not effective for other types of pain.

There are two main types of muscle relaxants that are antispastic (such as baclofen or dantrolene) for conditions such as cerebral palsy and multiple sclerosis and antispasmodic agents for musculoskeletal conditions. Muscle relaxants like other medicines also have some side effects. Dizziness, sleepiness, drowsiness, blurred vision, fluid retention, loss of balance, lack of coordination, dry mouth, and difficulty in concentrating are the side effects of the muscle relaxants.

People with certain medical conditions or who are taking certain other medicines can have problems if they take muscle relaxants. Anyone who has allergies, who is breastfeeding has kidney disease, has suffered a recent heart attack or irregular heartbeat, has an overactive thyroid gland, hepatitis or liver disease, is a current or former drug or alcohol abuser, has glaucoma, or has problems with urination should discuss their condition with their doctor before taking muscle relaxants. One thing is clear that muscle relaxants are the best solution for the muscle sprains, strains, and injuries.

Source: Pharmaexpressrx.com



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Muscle Relaxants and Its Usage

September 17th, 2010
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Simon Waker Haughtone asked:




A drug which decreases muscle tone by affecting skeletal muscle function is known as muscle relaxant. It blocks the transmission of nerve impulses or decreases excitability of motor-end plate or uses other ways to reduce muscle contractility. To put in a layman’s language, it is a drug which relieves and relaxes muscle tension.

Most of us may not be aware that muscle relaxants were used as early as 16th century in the South American continent. Arrow tips were dipped in poison to produce skeletal muscle paralysis which eventually leads to death. The present muscle are based on these principles. Those poison tipped arrows used curare as their poison. Curare was used in earlier studies of pharmacology as well. It has tubocurarine which was used in research of neuromuscular transmission.

Muscle relaxants are broadly classified in two categories as follows:-

Spasmolytics: Spasmolytics are also called as centrally acting muscle. It gets its name for it reduces spasticity in many neurological conditions. Spasmolytics normally act at brain stem, cortex and spinal cord or even all the three areas and hence they are called as relaxants which act centrally. Spasmolytics are also known as antispasmodic and are commonly used for low back pain, neck pain and headaches related to tension.

Neuromuscular Blockers: Neuromuscular blockers interfere with transmission at the neuromuscular end plate. These types of muscle relaxants have no CNS activity. They are normally used in intensive care units and surgical procedures. They are also used as an emergency medicine for causing paralysis. At around 1940, doctors started using neuromuscular-blocking medicines as muscle relaxants during surgeries.

Factors taken into consideration while choosing a muscle are side effects, efficiency, tolerance and cost. Adverse effects are a major worry for all muscle relaxants. These effects include drowsiness, dizziness and some major effects on our bodies as well. These drugs are recommended upon their tolerability with cost being a minor concern as efficiency is what people seem to look for.

Dantrolene is used for neurological conditions like multiple sclerosis and cerebral palsy. Rapid muscle contraction is more sensitive as compared to a muscle which contracts gradually. Dantrolene can have major effects like normal muscle weakness, sedation, and hepatitis in some cases. Carisoprodol, metaxalone, cyclobenzaprine and methocarbamol are commonly used for myofascial pain syndrome, fibromyalgia, low back and neck pain.

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How Effective Are Muscle Relaxants?

August 26th, 2010
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Yury Bayarski asked:




Muscle relaxants are effective in the management of low back pain. However, the side effects require that they should be used with caution.

Cyclobenzaprine hydrochloride has the most recent and largest clinical trials demonstrating its benefit, but carisoprodol, diazepam and metaxalone also appear to be effective.

In 1989 researches compared the effectiveness of cyclobenzaprine (Flexeril) alone with diflunisal (Dolobid), placebo, and a combination of cyclobenzaprine and diflunisal in the treatment of acute low back pain and spasm. During the ten-day study period, the combined treatment group demonstrated significantly superior improvements in global ratings on day four, but not on day two or seven. This study suggested some effectiveness of combined analgesic and muscle relaxant therapy when utilized early in the initial week of pain onset.

Another study compared the effects of combined cyclobenzaprine and naproxen (Naprosyn) with naproxen alone and also found combination therapy to be superior in reducing tenderness, spasm, and range of motion in patients with low back pain and spasm.

Cyclobenzaprine and carisoprodol were compared in the treatment of patients with acute thoracolumbar pain and spasm rated moderate to severe and of no longer than seven days duration. Both drugs were effective, without significant differences between the treatment groups. Significant improvements were noted in physician rated mobility and in patients’ visual analogue scores on follow up days four and eight. While 60% of patients experienced side effects in the form of drowsiness or fatigue, these differences were not significantly different between treatment groups and only eight percent of patients from each group discontinued treatment.

In an attempt to determine the mechanism of action of carisoprodol in the treatment of low back pain, a study was carried out comparing its effectiveness to that of a sedative medication butabarbital, and a placebo. Carisoprodol was significantly more effective in providing both pain relief and improvements in range of motion. The results of this study suggest that the effects of carisoprodol are not secondary to its sedative effects alone. In addition to the skeletal muscle-relaxing effects, carisoprodol also produces weak anticholinergic, antipyretic, and analgesic effects.

In an earlier study, diazepam (Valium) was found to offer no significant subjective or objective benefit, when compared to placebo, in patients treated for low back pain. Carisoprodol (Soma) was found to be superior to diazepam in the treatment of patients with “at least moderately severe” low back pain and spasm of no longer than seven days duration. In this study, the overall incidence of adverse reactions was higher in the diazepam treated group but was not of statistical significance.

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