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The Best Muscle Relaxants For Pain

Low back pain and neck pain are among the most common types of pain experienced by people at some point in their life. According to the Centers for Disease Control and Prevention (CDC), 25 percent of all adults in the United States had back pain within the past three months.  It is also estimated that up to 80 percent of all adults will experience back pain at some point in their lives. Neck pain is extremely common as well, and affects more than 30 percent of the entire population of the nation. Depending on the cause, low back and neck pain can either feel like a dull ache or a sharp and shooting pain, and it can be so intense that it can prevent people from doing normal daily activities. 

Causes of back pain can be due to a mechanical injury, congenital defects, degenerative problems that include disc degeneration, and nerve or spinal cord problems. It can also be due to non-spine sources such as kidney stones or fibromyalgia. If you experience symptoms of back pain that lasts for the duration of a few days up to a few weeks, you have acute back pain. This type of back pain is usually self-resolving and does not permanently affect functional abilities after it resolves. Chronic back pain lasts for three months or longer and can result in loss of function to varying degrees. The cause of chronic back pain can be hard to identify and pain often persists even after therapeutic measures like treatment and surgery are attempted. Chronic neck pain can interfere with living a healthy lifestyle too. In chronic conditions, treatment methods are focused on managing the pain in a way that allows you to continue living normally. 

Back and neck pain are treated with a combination of medications that help resolve the pain, along with physical therapy and exercises that help strengthen muscles. Skeletal muscle relaxants are one of the most common prescription drugs used to treat pain from muscle spasms and are mainly used for the treatment of acute back and neck pain. 

What are muscle relaxants?

When pain is a result of muscle spasms that arise due to injury, joint pain or other conditions, muscle relaxants can be very effective in relieving the pain. There are many muscle relaxants for joint pain or injury available on the market, and while most of them work in different ways, all of them relax muscle tightness and reduce stiffness. In general, muscle relaxers either treat spasms or spasticity. Muscle spasms are a localized musculoskeletal problem, whereas spasticity is caused by a spinal cord or brain injury and causes long-term muscle contraction.  These are two separate medical conditions that require different types of muscle relaxants.

Many people are not aware that muscle relaxants are not the first line treatment method used to treat back or neck pain. The non-steroid anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen or aspirin are recommended first to relieve pain associated with muscle spasms. Acetaminophen can also be used to help relieve pain in people who cannot take NSAIDs. If these drugs are ineffective, muscle relaxants can be a good option to relieve pain. 

Here is a guide to the best muscle relaxants for pain and what to expect from each. 

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Cyclobenzaprine

This muscle relaxant, also known as the brand name Flexeril or Amrix, is intended for short-term use for a maximum of two to three weeks at a dose range between 10 mg and 30 mg per day.  It is a popular choice for the treatment of sprains and muscle strain. Common side effects of this drug include drowsiness, dizziness, dry mouth and fatigue. Cyclobenzaprine is one of the most affordable options for muscle relaxants because cheap generic versions are available. Due to its sedative effects, it is usually taken at bedtime. Depending on the severity of muscle spasms, it can also be taken during the day, but it will limit activity quite a bit.  

Methocarbamol 

Methocarbamol (Robaxin) is used to treat severe muscle spasms and pain. Up to 1,500 mg of this drug can be taken orally every 8 hours for pain relief from acute back or neck pain and it is also administered intravenously at 1000 mg.  It is generally well tolerated by people who take it and a huge advantage of methocarbamol is that it does not cause as much sedation as other muscle relaxants. Common side effects include dizziness, blurred vision and sedation in some people. Overall, methocarbamol is a good choice if you are looking for an affordable muscle relaxant that can help pain due to muscle spasms with the least probability of being drowsy. 

Carisoprodol

Carisoprodol (Soma) is used to treat acute pain due to musculoskeletal reason. The drug is also meant for short term use at 250 to 350 mg doses up to three times a day. Taking carisoprodol for longer than this duration has not been proven to be effective. Carisoprodol causes several side effects like drowsiness or dizziness, and it can also cause headaches. The drug is a Schedule IV drug due to its potential for addiction, so it is better for people with a history of substance abuse to choose other muscle relaxants instead of carisoprodol. 

Metaxalone 

Metaxalone (Skelexin) is considered to be the most well-tolerated muscle relaxant available. It is usually taken three times a day at a dose of 800 mg each. Clinical studies demonstrated that metaxalone causes the least sedation and fewest side effects while still retaining its efficacy. Skelexin and generic versions of metaxalone are both quite expensive. Due to this, many insurance companies do not cover the drug. If not for the high cost, metaxalone would one of the most attractive muscle relaxants available. 

Diazepem (Valium) 

The benzodiazepine medications that include Valium are mainly used to treat anxiety, but they are sometimes prescribed for the treatment of acute back or neck pain caused my muscles spasms. Valium is taken at a dose of 2 to 10 mg up to four times a day, and it works by slowing down brain activity through desensitization of certain brain receptors. The medication is highly sedating and causes more side effects such as fatigue and weakness of muscles. Additionally, the incidence of addiction to Valium increases as you take it, so it should be avoided if this could be a problem for you.  

Baclofen 

Baclofen is used to treat spasticity instead of muscle spasms, unlike the rest of the drugs on the list before this. It is mainly used to treat spasticity that is caused by multiple sclerosis or a spinal cord injury. The medication can be taken orally or administered intravenously. While it is effective in providing relief from spasticity, it has a long list of side effects that include drowsiness, dizziness, headache, nausea, hypotension and convulsions.

Tizanidine 

Like Baclofen, tizanidine (Zanaflex), is another medication used to treat spasticity that is caused by multiple sclerosis or cerebral palsy. Head-to-head clinical studies comparing the efficacy of tizanidine with Baclofen have shown that both drugs work equally well in treating spasticity. However, tizanidine causes fewer side effects than Baclofen. These mainly include dry mouth, dizziness, weakness and feeling tired. 

Chlorzoxasone

Chlorzoxasone (Lorzone), like the other muscle relaxants used to treat muscle spasms, acts on the central nervous system to decrease pain caused by musculoskeletal problems. Some studies indicate that the drug is not that effective in treating acute low back or neck pain. This reason, combined with potential side effects of liver toxicity and stomach bleeding, have made chlorzoxasone less frequently used to treat pain due to acute muscle spasms. Other side effects include drowsiness, dizziness and lightheadedness.  

Orphenadrine

Orphenadrine (Norflex) is not one of the first recommended medications for standard back or neck pain due to a lack of data showing how well it works for this purpose. However, it is used to treat pain results from muscle spasms in some cases. Orphenadrine is effective for helping with motor control by decreasing trembling in patients with Parkinson’s Disease. 

Which muscle relaxant should you choose?

A valid prescription from a doctor is required to purchase all muscle relaxants on this list. You can discuss your symptoms and concerns about side effects with your doctor to choose a muscle relaxant that is the safe for you, and most likely to help you get relief from your pain. Insurance plans have different coverage policies on certain muscle relaxants and this can also help you with your selection. A free prescription drug discount card without any eligibility requirements can help you save on prescription muscle relaxants that may not be covered by your insurance. 

Taking muscle relaxants exactly as directed by your doctor is extremely important. 

Their long-term use can cause more harm than good, as they have been associated with increased tolerance. Due to this, they are mostly prescribed for acute pain and their use in managing chronic pain is very limited. Most often, muscle relaxants are a component of a combination therapy plan that includes rest, physical therapy and lifestyle changes, if needed.

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Published September 2nd, 2020 by Chris Riley
Fact Checked by Chris Riley

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