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
HA! Yes, maybe I should try that.
NO! It will only mask the symptoms for a short time, and if continue drinking to douse pain, you are looking at liver damage. That will make you feel bad even without back pain.
Strictly for ‘medicinal purposes’, you understand................
Do you folks have a spare bedroom for rent?
Soma works but they won’t prescribe it much
One thing that seems to work for me, very simple, I pull up a chair, lay on my back on the hard or carpet floor, and rest my legs on the chair from the knee down like L shape. Then minor stretching from that position arms back, arms out, stretch my neck, stretch side to side etc. 5-15 minutes of that offers relief for me anyway.
My ex-husband died at age 55 and my mother at age 64, both from alcoholism. So I am pretty careful to mostly avoid alcohol, other than a margarita or 2, when we eat out (pretty rare).
My experience is exactly the same. I take Flexeril before bedtime whenever I have lower back pain. It always works. I think what happens is that muscles cramp in my lower back and put traction on the nerves, causing pain and more cramping in a viscous cycle.
My old study confirmed that 35 years ago. Daily light exercise and stop running as exercise did it for me! My orthopedic surgeon told me that the human body was only meant to run from what was about to eat you. Jogging can kill you over time. For me he was correct. Swimming, walking, and a good mattresses logging plenty of time on it.
I am going to file this one in the “no shit” category.
If your discs are degenerating or damaged (as mine were and are), then there is nada that can quench that nerve pain (at least that isn’t addicting). Relax your muscles all you want, the nerve is still impinged, angry and letting you know 24/7. It sucks and usually ends in surgery.
I absolutely agree with this. Naproxen and massages and walks are about the best thing you can do. All muscle relaxers do is turn you into a drooling zombie that doesn’t care.
6 months of traction and physical therapy straightened out my back and neck injuries that i sustained when stopping a hit and run driver...
Muscle relaxants are ineffective against back pain caused by a herniated disk, which is the cause of most back pain.
Parafon forte worked for me. Kaiser won’t prescribe now because of age. Just allows lower back muscles to relax and de-sensitize.
I don’t doubt that:)
Humans have a big problem. We adapted to an upright gait when mothers ran with their children into cold water in order to avoid land predators. The pelvis formed “sciatic foramen”, holes through which run the sciatic nerves and the piriformis muscles. The cold water suppressed inflammation and swelling of the piriformis muscles. Therefore the foramen developed smaller than needed for inland and warm water operation.
Collagen around the piriformis/sciatic complex stiffens causing piriformis muscles to swell and trap the sciatic nerves against the pelvic foramen. Different people have different configurations of the sciatic/piriformis complex. These differences determine whether an individual’s sciatic nerve pulls the lower sciatic nerve in the leg or pulls the upper sciatic nerve in the spine.
Leg or spine, they are the same disease. They can be alleviated with tennis ball massage against the hip joint.
acupuncture from a competent operator also can work wonders ...
And it works.
Maybe it works best when used occasionally?
Tolerance build-up is a real problem........................
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