Clinical Report: Muscle Relaxants: Limited Long-Term Benefit for Pain
Overview
A systematic review found limited evidence supporting the long-term use of skeletal muscle relaxants (SMRs) for chronic pain, with some efficacy noted primarily for muscle spasms and neck pain. The review analyzed 44 studies involving 2,482 participants, revealing minimal benefits for conditions like fibromyalgia and low back pain.
Background
Chronic pain is a significant public health issue, and the use of skeletal muscle relaxants (SMRs) has increased in recent years. This review provides insights into the effectiveness of SMRs across various chronic pain syndromes.
Data Highlights
| Study Type | Participants |
|---|---|
| Randomized Clinical Trials | 1,314 |
| Cohort Studies | 1,168 |
| Total | 2,482 |
Key Findings
- Evidence of SMR efficacy was strongest for muscle spasms, painful cramps, and neck pain.
- SMRs showed little to no benefit compared to placebo for fibromyalgia, low back pain, and headaches.
- Cyclobenzaprine improved sleep disturbance but not other outcomes in fibromyalgia.
- Tizanidine showed improvements in pain intensity in cohort studies.
- Chlormezanone reduced sleep disturbances in neck osteoarthritis.
- 30% of patients using opioids were also prescribed SMRs.
Clinical Implications
Healthcare providers should be cautious when prescribing SMRs for chronic pain, particularly for conditions with limited evidence of benefit.
Conclusion
The review highlights the limited long-term benefits of SMRs for chronic pain management.
Related Resources & Content
- JAMA Network Open, 2024 -- Long-Term Use of Muscle Relaxant Medications for Chronic Pain: A Systematic Review
- VA/DoD Clinical Practice Guideline for Low Back Pain, 2022 -- Guidelines on SMR Use
- WHO Guideline for Non-Surgical Management of Chronic Primary Low Back Pain, 2023
- Frontiers in Medicine — Manual therapy combined with core muscle training for chronic non-specific low back pain in sedentary individuals: a study protocol for a single-center randomized controlled trial
- Pain Medicine — Pain relief by targeting nonrestorative sleep in fibromyalgia: a phase 3 randomized trial of bedtime sublingual cyclobenzaprine
- The ASCO Post — Expert Point of View: Brian D. Kavanagh, MD, MPH, FASTRO, and Zain A. Husain, MD
- Clinical Rheumatology — Utilizing Yoga to Improve Outcomes in Myositis, Muscular Dystrophies, and Various Musculoskeletal Conditions
- Long-Term Use of Muscle Relaxant Medications for Chronic Pain: A Systematic Review | Pharmacy and Clinical Pharmacology | JAMA Network Open | JAMA Network
- VA/DoD_CPG_the_Diagnosis_and_Treatment_of_Low_Back_Pain
- Executive summary - WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings - NCBI Bookshelf
- Oral non-benzodiazepine muscle-relaxants for people with acute and chronic primary low back pain: a systematic review with meta-analysis
- NDA Approval
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