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Choosing a skeletal muscle relaxant.
1St. John's University College of Pharmacy and Allied Health Professions, Jamaica, New York 11439, USA. sees@stjohns.edu
American Family Physician
|August 21, 2008
Summary
Skeletal muscle relaxants offer short-term relief for acute low back pain when other options fail. However, evidence is limited, and choices should prioritize side effects and patient factors over proven superiority.
Area of Science:
- Pharmacology
- Musculoskeletal Medicine
- Evidence-Based Practice
Background:
- Skeletal muscle relaxants are frequently prescribed for musculoskeletal conditions.
- Existing evidence for their efficacy often stems from methodologically weak studies.
- These agents have not demonstrated superiority over acetaminophen or NSAIDs for low back pain.
Purpose of the Study:
- To evaluate the effectiveness and comparative data of skeletal muscle relaxants.
- To inform clinical decision-making regarding the use of these medications.
Main Methods:
- Systematic reviews and meta-analyses were examined.
- Comparison studies of different skeletal muscle relaxants were assessed.
- Effectiveness and adverse effect profiles were analyzed.
Main Results:
- Systematic reviews support short-term use for acute low back pain if other analgesics are ineffective or not tolerated.
- No single skeletal muscle relaxant has proven superior to others in comparative studies.
- Cyclobenzaprine is well-studied; tizanidine and cyclobenzaprine offer sedation benefits, while methocarbamol and metaxalone are less sedating but have limited evidence.
- Common adverse effects include dizziness and drowsiness.
Conclusions:
- Skeletal muscle relaxants can be useful for acute low back pain but lack strong evidence of superiority.
- Selection should be individualized based on side effect profiles, patient preference, and drug interactions.
- Clear communication of potential adverse effects to patients is crucial.
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