Back in Control by M. D. Borenstein

Author:M. D. Borenstein [Borenstein, M. D.]
Language: eng
Format: epub
Publisher: M. Evans & Company
Published: 2001-11-28T05:00:00+00:00

MUSCLE RELAXANTS

The Agency for Health Care Policy and Research (AHCPR) has reviewed studies of muscle relaxants and concluded that they are probably as helpful as NSAIDs for low back pain, but they cause drowsiness in 30 percent of those taking them and are prescribed infrequently.

I have found that muscle relaxants are particularly helpful for muscle strain and its associated spasm. A recent study from a health maintenance organization in the state of Washington reported that an NSAID and a muscle relaxant were the most effective combination of medications for people with acute low back pain. Muscle relaxants can also be effective for chronic low back pain when you have limited motion because of muscle tightness.

The combination of NSAIDs and muscle relaxants is effective for reversing the “pain-spasm cycle,” characterized by muscle pain that causes increasing muscle spasm, and, thus, more pain and more spasm. An analgesic and muscle relaxant allows treatment of both components of the cycle. Treating just one component of the cycle may not correct the problem because either the pain or the spasm persists. A complete prescription requires both classes of drugs if you have muscle spasm.

We still do not know exactly how muscle relaxants work, but we do know they do not work directly on the muscles in the arms and legs. Their effect is on the central nervous system, which controls the tension in muscles. Thus, they work to reverse tension in the damaged muscle.

Like NSAIDs, beneficial response to muscle relaxants varies with the individual and so trial and error is sometimes necessary. I usually start patients on the lowest dose, taken two hours before sleep. Since the action of most muscle relaxants is delayed, taking them in the evening before sleep eliminates problems created by drowsiness. Muscle relaxants currently available are listed in appendix B.

Lucy’s back pain had a detrimental effect on her work as computer programmer, but also made it difficult to take care of her twelve-year-old child. She had so much difficulty walking that her twelve-year-old daughter was helping her put on her clothes and doing all the household chores. Lucy was becoming increasingly concerned about the burden her daughter was carrying. She was supposed to be practicing the violin, not taking care of her mother.

Examination revealed a severe degree of muscle spasm in the right buttock and lower back muscles. Although she had received NSAIDs in the past, she had never been given a muscle relaxant. I prescribed cyclobenzaprine (Flexeril), three times a day, along with her naproxen. Within two weeks, her back pain had decreased, and although she was still stiff, she was able to pick up more of the household chores. Lucy also started a stretching exercise program, and within another month she returned to work. Drug doses decreased over the next year, and she eventually used exercises exclusively as the means to control her pain and was able to sit comfortably at her daughters violin recital.

A wide range of muscle relaxants is available. Some of the medications include

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