Muscle relaxants significantly effective in treating trigeminal neuralgia, painful cramps and neck pain: Study

A recent systematic review published in the Journal of American Medical Association revealed that stricter opioid prescribing guidelines have led to an increase in prescriptions for skeletal muscle relaxants (SMRs) to manage chronic pain. 

The review followed a comprehensive search of multiple medical databases and sought to assess the effectiveness of long-term SMR use for various chronic pain conditions. The study focused on randomized clinical trials (RCTs) and cohort studies that evaluated the use of SMRs for at least one month in patients with chronic pain conditions such as low back pain, fibromyalgia, headaches, and painful muscle spasms or cramps.

The analysis included a total of 30 randomized clinical trials with 1,314 participants and 14 cohort studies involving 1,168 participants. Most of the studies focused on short-term use (between 4 to 6 weeks) of 9 different SMRs. Baclofen, tizanidine, and cyclobenzaprine were the most commonly studied muscle relaxants, where each examined in 11, 8 and 7 studies, respectively. Despite the wide variety of SMRs reviewed, the results showed limited evidence supporting their long-term effectiveness for many chronic pain conditions.

The review also found that SMRs were most effective in treating specific conditions such as trigeminal neuralgia, neck pain, and painful muscle cramps. However, for more common chronic pain conditions like fibromyalgia, low back pain, and headaches, SMRs did not offer significant benefits over placebo treatments. The outcomes highlighted that while some short-term relief was observed, the long-term use of SMRs may not be justified in these cases due to the lack of substantial evidence supporting their efficacy.

Common side effects of SMRs include sedation and dry mouth, which were frequently reported in the studies. The quality of evidence varied across the studies, with randomized clinical trials expressing low to moderate risk of bias, and cohort studies classified as having fair to good quality.

While SMRs may offer benefits for certain types of pain, such as neck pain or muscle cramps, clinicians should remain cautious for adverse effects and assess whether these drugs are achieving pain management goals. Overall, this study illuminates the need for more research into the long-term effects of muscle relaxants and calls for a careful approach to their use in chronic pain management in the context of reduced opioid prescriptions.

Source:

Oldfield, B. J., Gleeson, B., Morford, K. L., Adams, Z., Funaro, M. C., Becker, W. C., & Merlin, J. S. (2024). Long-Term Use of Muscle Relaxant Medications for Chronic Pain. In JAMA Network Open (Vol. 7, Issue 9, p. e2434835). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.34835