Although tens of thousands of Americans turn to muscle relaxants to relieve low back pain, a new Australian review finds little evidence that such drugs actually work.
That is the conclusion of a deep dive into 31 previous studies, which in total recruited more than 6,500 patients in low back pain.
Enrolled patients had treated low back pain with a wide range of 18 different prescription muscle relaxants.
But while the studies suggested that muscle relaxants could ease pain in the short term, “the effect is, on average, probably too small to be important,” said study author James McAuley.
“And most patients would not be able to feel any difference in their pain compared to taking placebo or sugar pills,”
Another concern: In addition to their ineffectiveness, “there is also an increased risk of side effects,” warned McAuley, director of the Center for Pain IMPACT with the University of New South Wales’ School of Health Sciences in Sydney.
Such side effects may include dizziness, drowsiness, headache or nausea in addition to the risk of patients developing a lingering addiction.
McAuley said his team was surprised by the results, “as previous research suggested that muscle relaxants reduced pain intensity.
However, when we included all the most up-to-date studies, the results became much less certain. “
One problem is that much of the research “was not done very well, which means we can not be very sure of the results,” McAuley said.
For example, none of the studies examined long-term use of muscle relaxants.
This means that the Australian team could only assess the effectiveness of muscle relaxants during two time frames: through an initial two-week regimen and between 3 and 13 weeks.
Initially, they found low evidence of a negligible pain relief benefit; otherwise, they found no pain intensity or benefit at all.
McAuley’s take-away: “There is a clear need to improve the research on low back pain so that we better understand whether medication can help people or not.
“Low back pain is extremely common. They experience 7% of the global population at a time. Most people, about 80%, will have at least one episode of low back pain during their lifetime,” McAuley noted.
However, because it is often very difficult to isolate an exact cause, many treatments – including NSAIDs, opioids, exercise therapy or counseling – aim to control pain rather than provide a cure.
Muscle relaxants – prescribed for 30 million Americans by 2020 – fall into that category, McAuley said.
Given that muscle relaxants provide neither a cure nor pain relief, there is “a clear need to develop and test new effective and cost-effective treatments for people with low back pain,” he said.
Meanwhile, McAuley says there is a move underway to “demedicate” low back pain by including techniques that focus on alternatives to medicine or surgery.
For example, “we know that people with low back pain should avoid staying in bed,” he remarked, “and they should try to be active and continue with usual activities, including work, as much as they can.
“People with recent low back pain should get advice and training on low back pain,” McAuley added. “[And] they need to be assured that they do not have a serious condition and that their low back pain is very likely to improve over time, whether they are taking medication or other treatment. “
He and his colleagues reported their findings this week in the BMJ.
“The problem is, back pain has so many causes,” said Dr. Daniel Park, Associate Professor in the Department of Orthopedics with Oakland University’s William Beaumont School of Medicine in Rochester, Mich.
So when it comes to treatment, “there is no one-size-fits-all,” stressed Park, who is also a spine surgeon at Beaumont Hospital-Royal Oak.
Park still believes that when it comes to muscle relaxants, “there is probably a place for short-term benefit to help patients cope with severe pain.”
For example, he suggests that patients with “muscle strain by overdoing it” or that people with a herniated disc may actually benefit from short-term use of muscle relaxants.
But patients with garden-black back pain from a degenerative disc? Not so much.
Either way, long-term pain relief is unlikely, regardless of the source of the problem, Park noted.
“Long-term, therapy and core reinforcement will be much more beneficial,” Park said, while every effort was made to identify the specific cause and minimize the risk of a chronic condition, permanent damage and lasting discomfort.
There is more about back pain at the US National Institute of Neurological Disorders and Strokes.
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