Muscle relaxants ‘very questionable’ treatment for low back pain, experts say

Commonly prescribed muscle relaxant drugs may offer some temporary relief for low back pain, but could also increase the risk of side effects, a new study shows.

A systematic review of almost 50 trials, sampling 6,505 participants, suggested that non-benzodiazepine antispasmodics, which are widely taken to suppress muscle spasms, might provide a small reduction in pain intensity when used over a period of two weeks or less for patients with acute low back pain.

But there was little to no effect of the drugs on the level of pain after three to 13 weeks, or on disability, the study showed.

The peer-reviewed results were published in the British Medical Journal (BMJ) on Wednesday.

“We would encourage clinicians to discuss this uncertainty in the efficacy and safety of muscle relaxants with patients,” the authors wrote.

“Although muscle relaxants are typically prescribed for short-term use, the effects of long-term use are not known.”

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Low back pain is the most common cause of disability worldwide, with eight in 10 people reporting the problem at some point in their lives, according to doctors.

Sometimes problems with the bones, soft tissues, or intervertebral discs of the spine cause back pain, but in the vast majority of cases there is nothing specific that can be pinned down as the culprit, said Douglas Gross, a professor of physical therapy at the University of Alberta.

“This is one reason why treating the pain with specific interventions is difficult,” he told Global News.

Over-the-counter muscle relaxant medications and prescription drugs are widely used to get relief from backaches. But they do not solve the root cause of the problem or prevent it from recurring in the future, said Danielle Carnegie, a physical therapist and PhD student of biomechanics at the University of Toronto (U of T).

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In the short run, the muscle relaxants might work, but they’re not something to use long term, said Jennifer Lake, an assistant professor at the Leslie Dean Faculty of Pharmacy at U of T.

“For the first few days, maybe they’re OK, but after that, they’re probably not giving you much benefit,” she told Global News.

The study also suggested that non-benzodiazepine antispasmodics could increase the risk of an adverse event being reported, such as dizziness, drowsiness, headache and nausea.

The very small positive effect on pain combined with some risk of adverse events makes this treatment “very questionable,” said Gross.

Instead of popping pills, there are other effective ways to manage and prevent back pain, experts say.

Gross said for acute low back pain, the best strategy was to stay as active as possible and avoid rest.

“We know that resting in bed for more than two days is counterproductive and actually prolongs the problem,” he told Global News.

Applying superficial heat at home, massage, manual therapy and acupuncture can also be helpful with few adverse effects.

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With people spending more time sitting at home in front of their TV screens and computers during the COVID-19 pandemic, Carnegie said it was important to take breaks, switch to a standing position and walk around.

And if you are sitting for an extended period to make sure “you’re in an upright position, that your feet are firmly planted in front of your chair,” she advised.

Carnegie also recommended different exercises such as side planks and bird dogs to make the core and spine strong.