Summary: A new study has raised concern regarding the widespread use of muscle relaxants for chronic pain. This new systemic review found that muscle relaxants might have some role in spasms, cramps, and neck pains, but they appear to have a limited role in the long-term management of chronic pain syndromes like low back pain and fibromyalgia.
Opioids are still among one of the most effective painkillers for chronic pain in carefully selected patients. However, the CDC now recommends avoiding using opioids due to safety concerns. This means that physicians are reducing prescribing opioids, instead preferring other ways of pain control.
However, this reduced opioid prescription has created other issues like insufficient pain control, causing patient distress, or even patients seeking illicit drugs. It also means that physicians are more frequently using drugs that might not be effective for chronic pain.
Many medications are good for acute pain, but chronic pain is quite different. Thus, drugs that work for acute pain often fail to help with chronic pain. However, physicians still extensively use such drugs in chronic pain, including muscle relaxants. One of the new clinical studies published in JAMA Network Open has questioned this approach. This latest study found that despite the widespread use of muscle relaxants, they have a limited role in most chronic pains. Moreover, physicians are recommending them despite the lack of robust clinical data supporting their use in such pain conditions.
So, experts say that physicians must be careful when prescribing muscle relaxants, and they need to be aware of the fact that they do not help in most chronic pains.
In the new study, researchers included 30 clinical trials with a total of 1,314 patients. So, even from the number of studies on the topic and patient number, one can understand that most studies have a very small sample size. Researchers looked at the data supporting the use of some of the most common muscle relaxants.
The study found that doctors generally prescribed muscle relaxants for four to twelve weeks. They looked at the use of the nine most common muscle relaxants. They found that the most commonly used muscle relaxants were (25%), tizanidine (18%), cyclobenzaprine (16%) and eperisone (11%).
Of course, researchers are not saying that these muscle relaxants do not work. They do work in some pain conditions, but they have a limited role in most chronic pain syndromes. Further, there are huge differences in various muscle relaxants, and these differences must be understood.
Thus, researchers found that tizanidine was most effective for controlling chronic headaches. Nonetheless, much contradicting data exists, and not all studies support its use for treating chronic headaches.
Similarly, studies show some benefits in headaches by using baclofen, especially along with carbamazepine. However, most studies had a small sample size. Not only that, studies show that such a combination frequently causes severe side effects like sedation, vomiting, nausea, constipation, and more.
However, researchers found that muscle relaxants were quite good for managing cramps. Thus, baclofen seems to help well. However, it was not superior to other safer pain relief methods like transcutaneous electrical nerve stimulation.
Overall, researchers found that short-term use of muscle relaxants is beneficial for certain conditions like spasms, cramps, and neck pain. However, long-term use of these drugs in chronic pain conditions like fibromyalgia, low back pain, and headaches appears to have little value. Moreover, some of the muscle relaxants may cause severe side effects.
Best thing you can do is consult with chronic pain specialists to help understand where you are experiencing pain, and they will suggest the most effective medication
Source:
Oldfield, B. J., Gleeson, B., Morford, K. L., Adams, Z., Funaro, M. C., Becker, W. C., & Merlin, J. S. (2024). Long-Term Use of Muscle Relaxant Medications for Chronic Pain: A Systematic Review. JAMA Network Open, 7(9), e2434835. https://doi.org/10.1001/jamanetworkopen.2024.34835
