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Skeletal muscle relaxants are widely used in treating musculoskeletal conditions. However, evidence of their effectiveness consists mainly of studies with poor methodologic design. In addition, these drugs have not been proven to be superior to acetaminophen or nonsteroidal anti-inflammatory drugs for low back pain. Systematic reviews and meta-analyses support using skeletal muscle relaxants for short-term relief of acute low back pain when nonsteroidal anti-inflammatory drugs or acetaminophen are not effective or tolerated. Comparison studies have not shown one skeletal muscle relaxant to be superior to another. Cyclobenzaprine is the most heavily studied and has been shown to be effective for various musculoskeletal conditions. The sedative properties of tizanidine and cyclobenzaprine may benefit patients with insomnia caused by severe muscle spasms. Methocarbamol and metaxalone are less sedating, although effectiveness evidence is limited. Adverse effects, particularly dizziness and drowsiness, are consistently reported with all skeletal muscle relaxants. The potential adverse effects should be communicated clearly to the patient. Because of limited comparable effectiveness data, choice of agent should be based on side-effect profile, patient preference, abuse potential, and possible drug interactions. (Am Fam Physician. 2008;78(3):365-370. Copyright © 2008 American Academy of Family Physicians.)
Skeletal muscle relaxants are often prescribed for musculoskeletal conditions including low back pain, neck pain, fibromyalgia, tension headaches, and myofascial pain syndrome. The goals of treatment include managing muscle pain and improving functional status so the patient can return to work or resume previous activities.
Skeletal muscle relaxants are divided into two categories: antispastic (for conditions such as cerebral palsy and multiple sclerosis) and antispasmodic agents (for musculoskeletal conditions). A antispastic agents (e.g., baclofen [Lioresal], dantrolene [Dantrium]) should not be prescribed for musculoskeletal conditions because there is sparse evidence to support their use. rather, an antispasmodic agent may be more appropriate (Table 1).1-9
Among antispasmodic agents, carisoprodol (Soma), cyclobenzaprine (Flexeril), metaxalone (Skelaxin), and methocarbamol (Rrobaxin) were among the top 200 drugs dispensed in the U united States in 2006.10,11 Despite their popularity, skeletal muscle relaxants should not be the primary drug class of choice for musculoskeletal conditions. The american Pain Society and the american College of Physicians recommend using acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line agents for acute low back pain and reserving skeletal muscle relaxants as an alternative treatment...