Posted on 07/08/2021 9:04:35 AM PDT by Red Badger
And might increase the risk of side effects.
Muscle relaxant drugs are largely ineffective for low back pain, despite being widely prescribed for this condition, suggests an analysis of the latest evidence published by The BMJ today.
The findings show that muscle relaxants might reduce pain in the short term, but the effect is too small to be considered clinically meaningful, and there is an increased risk of side effects.
But the researchers stress that the certainty of evidence is low and say large trials are urgently needed to resolve uncertainties around the use of these drugs for back pain.
Low back pain is a global public health problem and muscle relaxants (a broad class of drugs that include non-benzodiazepine antispasmodics and antispastics) are a commonly prescribed treatment.
For example, in 2020, prescriptions in England exceeded 1.3 million, and in the US more than 30 million. Yet around the world, clinical practice guidelines provide conflicting recommendations for their use.
To address this, researchers in Australia investigated the effectiveness, acceptability, and safety of muscle relaxants compared with placebo, usual care, or no treatment in adults with non-specific low back pain.
They reviewed and carried out a detailed analysis of evidence from 31 randomized controlled trials involving over 6,500 participants, published up to February 2021.
The trials were of varying quality, but the researchers were able to assess the certainty of evidence using the recognized GRADE system.
They set a difference of at least 10 points on a 0 to 100 point scale for pain and disability to be the smallest clinically important effect – a threshold used in other low back pain studies.
Very low certainty evidence showed that non-benzodiazepine antispasmodic drugs might reduce pain intensity at two weeks or less for patients with acute low back pain compared with controls. But this effect is small – less than 8 points on a 0-100 point scale – and does not meet common thresholds to be clinically meaningful.
There was little to no effect of non-benzodiazepine antispasmodics on pain intensity at 3-13 weeks or on disability at all follow-up time points.
Low and very low certainty evidence also showed that non-benzodiazepine antispasmodics might increase the risk of adverse events (commonly, dizziness, drowsiness, headache and nausea) and might have little to no effect on treatment discontinuation compared with controls.
No trials evaluated the effect of muscle relaxants on long term outcomes.
Although this analysis was based on the best available trial evidence, the researchers acknowledge some limitations, and say the modest overall effect could still mean that some, but not all, individuals gain a worthwhile benefit.
However, they stress that the low to very low certainty of evidence does not allow any firm recommendations.
“We would encourage clinicians to discuss this uncertainty in the efficacy and safety of muscle relaxants with patients, sharing information about the possibility for a worthwhile benefit in pain reduction but increased risk of experiencing a non-serious adverse event, to allow them to make informed treatment decisions,” they write.
“Large, high quality, placebo-controlled trials are urgently needed to resolve uncertainties about the efficacy and safety of muscle relaxants for low back pain,” they conclude.
Reference: 7 July 2021, The BMJ. DOI: 10.1136/bmj.n1446
Steroids works for me whenever I have a flare-up..................
I take Flexeril once in a blue moon when I overwork and tweak my muscles in my back. I disagree that this muscle relaxer doesn’t help. It does, in combination with a little bit of Advil. I usually only need it for one day, and maybe once a year, if that, though my situation probably isn’t what they are referring to in this article. It really helps me when I need it.
This report is BS. Opiods (specifically oxycodone) alone don’t work very well for me; neither do muscle relaxants. But the two used in combination work extremely well. The same for my wife.
Me too. I use Flexerall once in while after playing golf. It cures muscle spasms quickly.
Buy an inversion board (no you dont need a $500 Teeter board). They make them for $100 and hanging at just a 45 degree angle does wonders for sciatica!
Same for the wife. Chiro did nothing either. Massage took away excruciating pain. She goes every two weeks now.
Your back will be on fire for those first twelve minutes, but this works:
https://www.youtube.com/watch?v=4BOTvaRaDjI
Whiskey is a wonderful muscle relaxant. I take a bit just before bedtime when my back is acting up.
Debilitating back pain is horribly demoralizing. I used to suffer from it frequently but I’ve gotten pretty good at avoiding it by making changes to the way I work, sleep and play.
I need one of those.
Have two!..........................
They never seemed to help me.
Me either..................
I take a muscle relaxer every night at bedtime.
Honestly, Gabapentin helps my pain more than the muscle relaxants. My muscle relaxer, Tizanidine, works better for sleep.
Congratulations to you on succeeding at keeping the back pain at bay. I am trying very hard to do better at avoiding it. Tight muscles due to tension, then pinched nerve... it is improving so slowly, but has been several months now.
MY muscle relaxer, Crown Royal, works better for sleep......................
Rule # 1: If over age 30, do not lift anything heavy.
Rule # 2: Use your legs, not your back to lift. In other words keep torso straight up when picking things off ground.
Rule # 3: Most important rule...walk at least 3000 steps every day. Walking will help strengthen muscles in lower back. Weak muscles means more load on bone joints in spine.
Knock on wood, with my relentless 25 minute walk on treadmill minimum 5 days every week (if I mow the lawn, or do any other strenuous activity, I skip the gym), I am painless at age 81.
I have cut down slope of treadmill from 3 degrees up to 1.5 to minimize cramps in lower foot.
https://www.youtube.com/watch?v=I55ZxIwbuOU
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