Summary: A new study raises concern about the wide use of muscle relaxants for chronic pain. This review found that muscle relaxants may help with spasms, cramps, and neck pains. But they seem to do little for the long-term care of chronic pain conditions like low back pain and fibromyalgia.
Opioids are still among the most effective painkillers for chronic pain in carefully chosen patients. But the CDC now advises avoiding opioids because of safety concerns. So doctors are prescribing fewer opioids and using other ways to control pain.
But fewer opioid prescriptions have caused other problems. Pain goes poorly controlled, patients suffer, and some even turn to illegal drugs. It also means doctors more often use drugs that may not work for chronic pain.
Many drugs work well for short-term pain, but chronic pain is quite different. So drugs that work for short-term pain often fail for chronic pain. Yet doctors still widely use such drugs for chronic pain, including muscle relaxants. A new study in JAMA Network Open questions this approach. It found that muscle relaxants, though widely used, do little for most chronic pain. And doctors recommend them without strong clinical data to back their use in these conditions.
So experts say doctors must be careful when prescribing muscle relaxants. They need to know these drugs do not help in most chronic pain.
The new study included 30 clinical trials with a total of 1,314 patients. Just from those numbers, you can see that most studies were very small. The researchers looked at the data behind some of the most common muscle relaxants.
Doctors usually prescribed muscle relaxants for four to twelve weeks. The researchers looked at the nine most common muscle relaxants. They found that the most used were (25%), tizanidine (18%), cyclobenzaprine (16%) and eperisone (11%).
Of course, the researchers are not saying these muscle relaxants do not work. They do work in some pain conditions. But they do little for most chronic pain conditions. And the various muscle relaxants differ a lot, and those differences must be understood.
The researchers found that tizanidine worked best for chronic headaches. Still, the data conflict, and not all studies support using it for chronic headaches.
In the same way, studies show some benefit for headaches from baclofen, especially with carbamazepine. But most studies were small. And this combination often causes severe side effects like sleepiness, vomiting, nausea, constipation, and more.
The researchers did find that muscle relaxants work quite well for cramps. Baclofen seems to help well. But it was no better than safer pain relief methods like transcutaneous electrical nerve stimulation.
Overall, short-term use of muscle relaxants helps with certain conditions like spasms, cramps, and neck pain. But long-term use for chronic pain conditions like fibromyalgia, low back pain, and headaches seems to have little value. And some muscle relaxants may cause severe side effects.
The best thing you can do is see chronic pain specialists. They will help find where your pain comes from and suggest the medicine that works best.
Frequently asked questions
What happens if you take muscle relaxers for a long time?
For most chronic pain, not much good. A JAMA Network Open review of 30 trials and 1,314 patients found that long-term use of muscle relaxers in fibromyalgia, low back pain and headaches has little value. Some of these drugs also cause severe side effects. For example, baclofen with carbamazepine often causes sleepiness, nausea, vomiting and constipation.
What are muscle relaxers actually good for?
Short-term use helps with muscle spasms, cramps and neck pain. Baclofen works well for cramps. Doctors usually prescribe muscle relaxers for four to twelve weeks. The problem starts when a drug made for a short flare becomes a long-term plan for chronic pain. Chronic pain is a different disease from short-term pain.
Do muscle relaxers help fibromyalgia or chronic back pain?
Not over the long term. The review found that muscle relaxers do little for chronic pain conditions like low back pain and fibromyalgia. Yet doctors keep prescribing them for both. Most of the studies behind that prescribing were small. The data for long-term use in these conditions is thin.
What can I take instead of a muscle relaxer?
For cramps, baclofen was no better than transcutaneous electrical nerve stimulation (TENS), a safer way to ease pain. For chronic pain, the better move is to see a chronic pain specialist. They pin down where the pain comes from and suggest the treatment that works best for it.
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
Dr. Gurpreet Singh Padda, MD, MBA, MHP
