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Muscle Relaxants

Overview

Definition

 

Muscle Relaxants

  • These are used to treat different types of musculoskeletal conditions. Their uses are not limited to chronic pain.
  • Research on muscle relaxants is limited. Some research indicates that muscle relaxants are more effective for short-term pain than chronic pain. 
  • More effective than Tylenol and NSAIDs for low back pain (See et al., 2008).

Medications

  • Baclofen
    • Used in the treatment of spasticity
    • May be useful in the treatment of spinal cord injuries (de Sousa et al., 2023)
    • May be effective in reducing chronic pain related to spasticity (Marathe et al., 2021)
    • Can be given orally and intrathecally (administered directly into the spine)
    • Most common side effects: drowsiness, dizziness, and weakness
  • Metaxalone
    • Centrally acting muscle relaxant (centrally acting means it works on the brain and spinal cord because they control your muscles)
    • Can be given for painful musculoskeletal conditions
    • It starts working within one hour and lasts for four to six hours (Chang, 2020)
    • On rare occasions, it can cause hemolytic anemia (Onyechi et al., 2023)
    • Side effects: nausea, vomiting, dizziness
  • Methocarbamol (also known as Robaxin)
    • This can be given orally, by injection, or through an IV.
    • It can be given for involuntary musculoskeletal spasms
    • It has been used for acute and chronic low back pain, arthritis, fibromyalgia, rib fractures, myofascial pain, and post-surgical pain (Sibrack et al., 2024).
    • It is ineffective for muscle spasms caused by upper motor neuron injury (Sibrack et al., 2024).
    • It takes about 30 minutes for the effects to be noticed.
    • Side effects: drowsiness and dizziness
  • Cyclobenzaprine (also known as Flexeril)
    • Relieves muscle spasms without disrupting motor function
    • It has been proven to be effective for acute back pain (Braschi et al., 2015)
    • This medication is ideal for short-term pain
    • Side effects: drowsiness, dizziness, and dry mouth
    • This medication should only be used for short periods of time such as 2-3 weeks
  • Diazepam (also known as Valium)
    • Works on GABA receptors within the central nervous system (Chang, 2020)
    • Can be used for anxiety, seizures, and muscle spasms
    • A study showed that diazepam is more effective than methocarbamol for relieving low back pain. However, there is a higher risk for drowsiness with diazepam (Sharifi et al., 2023)
    • Can be given orally, rectally, through an injection or IV, and intranasally
    • Can be used vaginally for pelvic floor dysfunction and urogenital pain (Carrico et al., 2011)
    • Most common side effects: poor muscle control and drowsiness
    • Avoid using in combination with opioids and alcohol
  • Tizanidine
    • Given for muscle spasticity caused by central nervous system disorders such as spinal cord injury, stroke, and multiple sclerosis (Chang, 2020)
    • Can be used for musculoskeletal pain syndromes and has been prescribed off-label for migraine headaches, insomnia, and as an anti-convulsant (Ghanavatian et al., 2023)
    • Most common side effects: dry mouth, dizziness, drowsiness, weakness
  • Orphenadrine
    • Can reduce tremors and stiffness (Chang, 2020)
    • Given for Parkinson’s disease
    • Can be given orally or by injection

 

Sources

Braschi E, Garrison S, Allan GM. Cyclobenzaprine for acute back pain. Can Fam Physician. 2015 Dec;61(12):1074. PMID: 26668287; PMCID: PMC4677944.

 

Carrico DJ, Peters KM. Vaginal diazepam use with urogenital pain/pelvic floor dysfunction: serum diazepam levels and efficacy data. Urol Nurs. 2011 Sep-Oct;31(5):279-84, 299. PMID: 22073898.

 

Chang WJ. Muscle Relaxants for Acute and Chronic Pain. Phys Med Rehabil Clin N Am. 2020 May;31(2):245-254. doi: 10.1016/j.pmr.2020.01.005. Epub 2020 Mar 13. PMID: 32279727.

 

de Sousa N, Pinho AG, Monteiro S, Liberato V, Santos DJ, Campos J, Cibrão JR, Silva NA, Barreiro-Iglesias A, Salgado AJ. Acute baclofen administration promotes functional recovery after spinal cord injury. Spine J. 2023 Mar;23(3):379-391. doi: 10.1016/j.spinee.2022.09.007. Epub 2022 Sep 23. PMID: 36155240.

 

Ghanavatian S, Derian A. Tizanidine. 2023 Aug 28. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30137790.

 

Marathe A, Allahabadi S, Abd-Elsayed A, Saulino M, Hagedorn JM, Orhurhu V, Karri J. Intrathecal Baclofen Monotherapy and Polyanalgesia for Treating Chronic Pain in Patients with Severe Spasticity. Curr Pain Headache Rep. 2021 Dec 11;25(12):79. doi: 10.1007/s11916-021-00994-9. Erratum in: Curr Pain Headache Rep. 2022 Mar;26(3):279. PMID: 34894303.

 

Onyechi A, Ohemeng-Dapaah J, Patel R, Onyechi E, Oyenuga M, Sartaj S, Mehta M, Lacasse A, Anyadibe IE. Metaxalone-induced Immune Hemolytic Anemia. J Community Hosp Intern Med Perspect. 2023 Sep 2;13(5):86-89. doi: 10.55729/2000-9666.1236. PMID: 37868679; PMCID: PMC10589045.

 

See S, Ginzburg R. Choosing a skeletal muscle relaxant. Am Fam Physician. 2008 Aug 1;78(3):365-70. PMID: 18711953.

 

Sharifi M, Abdorazzaghnejad A, Yazdchi M, Bahreini M. Methocarbamol versus diazepam in acute low back pain in the emergency department: a randomised double-blind clinical trial. Emerg Med J. 2023 Jul;40(7):493-498. doi: 10.1136/emermed-2021-211485. Epub 2023 Apr 17. PMID: 37068928.

 

Sibrack J, Patel P, Hammer R. Methocarbamol. 2024 May 2. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 33351427.