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MUSCLE RELAXANTS GUIDE FOR BACK AND NECK PAIN…

I have written a few articles recently on different types of muscle relaxants which were having some bad publicity. However Spine Universe have a great guide on muscle relaxants for back and neck pain. The Muscle Relaxants Guide from Spine Universe is expertly written by Jason M. Highsmith, MD specializing in brain and spine surgery, and is a valuable “one-stop-shop” for all things related to muscle relaxants.

There are a ton of different types of muscle relaxants on the market treating different types of muscle pain. The trouble is that many have quite a few side effects but this can be sorted by either trying a different type (see the list below) or taking it at a different time of day. It is always worth going back to your GP if you feel the muscle relaxant you have been given is not suitable for you as you can see from the comprehensive list below there are a number to choose from. This list and guide also includes the usual sort of side effects from different drugs.

Muscle relaxants are medications that help reduce muscle spasms, which are involuntary muscle contractions caused by a spine-related problem, such as whiplash, fibromyalgia, or low back strain. Often, muscle spasms cause severe pain and may limit your mobility.

Your doctor may prescribe a muscle relaxant to ease muscle spasms, reduce pain, and help your muscles move better. When your muscles move better, it makes other spine pain treatments, such as physical therapy, stretching, and exercise, more effective.

Understanding Spasticity Versus Spasm

Muscle relaxants treat two conditions: spasticity and spasm. Spasticity is marked by long-term muscle contraction caused by a brain or spinal cord injury. Spasms, on the other hand, are localized and occur because of a musculoskeletal issue.

Prescription muscle relaxants fall into 2 groups: antispastics and antispasmodics.

  • Antispastics are prescribed to treat spasticity caused by neurological disorders, such as cerebral palsy or spinal cord injury.
  • Antispasmodics are used to treat occasional muscle spasms.

While some antispasmodics may treat spasticity in addition to spasms, antispastics should not be used to treat spasms.

Muscle Relaxants for Muscle Spasms

Muscle spasms are painful and may restrict mobility, which can limit your ability to perform even basic activities. Painful, tight muscles can also interfere with getting a good night’s sleep.

Prescription Medications

If your muscle pain persists, your doctor may prescribe a muscle relaxant in addition to your pain medication. Find the medicine you’ve been prescribed on one of the two lists below.

SpineUniverse

Antispasmodics: Centrally Acting Skeletal Muscle Relaxers

Below are common antispasmodics (the generic names are listed first, with a brand name example in parentheses). Remember, these medications generally treat acute muscle spasms. If you’ve been diagnosed with a neurological disorder that causes spasticity, look for your medication on the list of antispastics:

Carisoprodol (Soma)

Carisoprodol is a centrally acting muscle relaxant. It is indicated for adults and teens age 16 or older. Carisoprodol comes in tablet form in dosages of 250 to 350 mg. Typical instructions are to take it three times a day and at bedtime. Carisoprodol can be habit forming and should only be used for two to three weeks.  

Chlorzoxazone (Lorzone, Parafon Forte DSC, Remular-S)

Chlorzoxazone is a skeletal muscle relaxant useful for treating acute muscle strains, including in the back. It comes in tablet form, and a typical dose for adults is 500 mg three or four times a day. One of the side effects associated with chlorzoxazone is red or purple urine. This is due to the way your body metabolizes the drug and is not a cause for concern.                      

Cyclobenzaprine (Amrix)

Cyclobenzaprine is another skeletal muscle relaxant. It comes as a tablet, suspension, or extended release capsule. Cyclobenzaprine should not be used by people who have certain heart conditions such as heart failure, a recent heart attack, or forms of arrythmia.

Metaxalone (Skelaxin)

Metaxalone is a centrally acting muscle relaxer, usually given in tablet form, 800 mg three to four times a day. Although drowsiness, irritability, and stomach or bowel upset are the most common side effects, metaxalone carries a long list of less common potential side effects, according to Mayo Clinic

Methocarbamol (Robaxin)

Like the other medications in this section, methocarbamol is a centrally acting skeletal muscle relaxant. A total of 1500mg a day, split up into three 500mg tablets or two 750mg tablets, is a standard dose. It has a fairly long list of potential side effects, so it is important to only take this and other muscle relaxants as directed by your doctor.

Orphenadrine (Norflex)

Orphenadrine is both a muscle relaxant and an anticholinergic—a drug that blocks the neurotransmitter acetylcholine. Because of its anticholinergic properties, orphenadrine is often used to control tremors caused by Parkinson’s disease. A typical dose is 200mg to 250mg total, taken two or three times a day. 

Antispastics

You are more likely to be prescribed an antispastic if your muscle spasticity is due to a neurological condition such as a spinal cord injury. These drugs are not typically used to treat the occasional muscle spasm.

Baclofen (Ozobax)

Baclofen, like the next drug on this list, is used for chronic neurogenic conditions that cause spasticity, such as multiple sclerosis or spinal cord injuries. Medication on the previous list—antispasmodics—are more appropriate for acute muscle spasms. 

Tizanidine (Zaniflex)

This skeletal muscle relaxant is often used to treat muscle spasms caused by multiple sclerosis, an autoimmune condition that attacks the fatty, insulating myelin sheaths that encase part of your nerve cells (and a close cousin of transverse myelitis). 

Off-label Medications for Spasticity

Sometimes doctors and researchers discover new uses for existing medications. These so-called off-label uses need time and testing to make it into the official FDA-approved list of uses. The following medications are not antispastics or antispasmodics, but can still help some people with spasticity and muscle spasms.

Benzodiazepines

Benzodiazepines (often abbreviated as “benzos”) such as oxazepam and diazepam (Valium) are sedatives that are usually used as anti-anxiety medications but can often treat back pain and muscle spasms. Researchers believe these drugs work by tamping down on nerve activity by modifying a neurotransmitter.

Common benzodiazepines include:

  Alprazolam (Xanax)

·         Clonazepam (Klonopin)

·         Lorazepam (Ativan)

Because they’re sedatives, the most common side effects are:

·         Drowsiness

·         Dizziness

·         Weakness

·         Balance trouble

Benzodiazepines are also addictive and carry the risk of overdose. Be sure to take them only and exactly as your doctor indicates.

Clonidine

Clonidine, sold under the brand names Catapres and Kapvay, usually treat attention deficit hyperactivity disorder (ADHD) and high blood pressure. Clonidine may react strongly with alcohol and can cause a host of side effects, including:

·         Dry mouth

·         Fatigue

·         Nausea

·         Headache

·         Rash

·         Hives

·         Difficulty swallowing or breathing

…and others.  

Gabapentin

Gabapentin (Gralise, Horizant, Neurontin) is an anticonvulsant medication effective at controlling epileptic seizures and restless legs syndrome. It is also frequently used to treat nerve pain and muscle spasticity. Gabapentin can cause many side effects—some severe—such as:

·         Drowsiness

·         Fatigue

·         Headache

·         Vision trouble

·         Cognitive issues

·         Vomiting

·         Bowel changes

·         Weight gain

Difficulty breathing

Over-the-counter Options for Muscle Spasms

Muscle relaxants may help reduce pain, and improve movement and range of motion, but your doctor will likely recommend that you first try acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID). In some cases, these over-the-counter medications will be enough to help alleviate your pain.

NSAIDs

NSAIDs are some of the most common OTC medications for pain in general. This class of drugs include:

  • Aspirin (Bayer, Excedrin)
  • Ibuprofen (Motrin, Advil)
  • Naproxen (Aleve)

Side effects are generally mild and can include upset stomach, diarrhea, and gas. NSAIDs may increase the risk of bleeding when combined with some medications such as blood thinners and selective serotonin reuptake inhibitors (SSRIs), which are antidepressants.

Acetaminophen

Sold under the brand name Tylenol (among others), acetaminophen is another popular choice for over-the-counter pain relievers. It often has fewer side effects than NSAIDs but won’t relieve inflammation.

Special Considerations and Potential Muscle Relaxant Side Effects

Habit Formation

Muscle relaxants for acute back or neck pain are usually prescribed to relieve short-term muscle pain—and some can be habit-forming. For these reasons, most doctors will write prescriptions with less than 2 weeks’ worth of medication. To reduce your risk of dependency or abuse, use your medication exactly as your doctor prescribes.

Drowsiness and Dizziness

The most common side effects associated with muscle relaxants are drowsiness and dizziness. This is because muscle relaxants depress your central nervous system, making you less alert and attentive. As such, avoid alcohol and don’t perform tasks that require your complete attention, such as operating machinery or driving, while taking a muscle relaxant.

Drug Interactions

Muscle relaxants pose health risks when they are taken with certain medications and supplements, including but not limited to:

  • Opioids
  • Sleep aid medications
  • St. John’s wort

Make sure your doctor knows every medication and supplement you are taking before starting muscle relaxant therapy.

When to Call Your Doctor

Muscle spasms are one of the more likely back pain causes to spontaneously resolve—that is, go away on their own—in two weeks or so. Talk to your primary care provider or spine specialist if your pain lasts for longer than two weeks.

Other situations in which you may want your physician’s opinion include:

  • New incidence of spasticity, especially if you don’t know what’s causing it
  • Spasticity that has become more severe or more frequent
  • Severe and frequent muscle spasms
  • Having side effects from your muscle relaxant
  • Frozen joints due to muscle contractions limiting range of motion

Muscle Relaxants: Part of a Multidisciplinary Treatment Plan

If your muscle pain doesn’t respond to over-the-counter medications, then muscle relaxants may be a good treatment option to alleviate your muscle spasms. For best results, muscle relaxants should be viewed as part of a treatment plan that may include gentle stretching, physical therapy, and exercise—not the sole treatment. As always, don’t hesitate to discuss your medications and comprehensive spine health plan with your doctor. A solid understanding of your therapeutic options is a strong defense against back pain.

Source: Spine Universe

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