Muscle relaxers are used in addition to rest, physical therapy, and other measures to relieve discomfort. They are typically prescribed for short-term use to treat acute, painful musculoskeletal conditions. Muscle relaxers are occasionally prescribed for chronic pain (pain lasting longer than 3 months).
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Muscle relaxers are not a class of drugs—meaning they do not all have the same chemical structure or work the same way in the brain. Rather, the term muscle relaxer is used to describe a group of drugs that act as central nervous system depressants and have sedative and musculoskeletal relaxant properties.
Muscle relaxers may be prescribed to treat back pain:
- Early in the course of back pain, on a short-term basis, to relieve pain associated with muscle spasms
- When back pain causes insomnia (for their sedative effect)
Muscle relaxers are also prescribed for other conditions such as fibromyalgia, multiple sclerosis, and seizure disorders.
There are several types of muscle relaxer medications commonly used to treat back pain.
Common Muscle Relaxants
Muscle relaxers are usually prescribed to treat back pain in conjunction with rest and physical therapy. Common muscle relaxants include:
- Baclofen. Muscle tightness and muscle spasms, including those related to spine injuries, may be eased with baclofen. The medication may be helpful in treating multiple sclerosis and stabbing nerve pain. It is available as a tablet and can be taken by children as young as 12 years old. Some common side effects could include nausea and vomiting, confusion, drowsiness, headache, or muscle weakness. Baclofen is rated C in the FDA’s A through X pregnancy safety ranking for medications, with A being the safest. The C category means that the medication should only be used if the benefits outweigh the risks.
- Benzodiazepines. In addition to treating anxiety, alcohol withdrawal, and seizure disorders, such as epilepsy, benzodiazepines can also treat muscle spasms and skeletal pain. Benzodiazepines, such as diazepam (Valium), lorazepam (Ativan), and temazepam (Restoril), are typically only intended for short-term use. This limitation is due to their habit-forming potential and because they alter sleep cycles, leading to sleep difficulties once the drug is stopped. Benzodiazepines are sold as tablets, liquid, injections, and rectal gels. People who have myasthenia gravis, severe liver disease, serious breathing troubles, or some forms of glaucoma, should avoid taking diazepam. All benzodiazepines are rated D by the FDA for safety during pregnancy and are not recommended for women who are pregnant.
- Carisoprodol (Soma). Carisoprodol relaxes muscles and eases pain and stiffness caused by acute bone and muscle problems, often caused by an injury. It is taken by mouth in tablet form and is also available in combination with aspirin or aspirin and codeine. Carisoprodol can be habit-forming, particularly if used in conjunction with alcohol or other drugs that have a sedative effect, including opioids (such as codeine). Common side effects include drowsiness, dizziness, and headache. People with a history of blood disorders, kidney or liver disease, and seizures may need to avoid Carisoprodol. It is rated C in the FDA’s pregnancy safety ranking for medications.
- Chlorzoxazone (Lorzone). Chlorzoxazone is used for the relief of discomfort from acute, painful, musculoskeletal conditions. Chlorzoxazone is available as a tablet. Common side effects include drowsiness, dizziness, and nausea. Chlorzoxazone is not recommended for people with liver disease. It has not been rated by the FDA for safety during pregnancy.
- Cyclobenzaprine (Amrix, Fexmid, FlexePax Kit, FusePaq Tabradol). Cyclobenzaprine eases stiffness and pain from muscle cramps, also called muscle spasms. It is available as a tablet and extended-release capsule. Cyclobenzaprine itself is not intended for long-term use (more than 2 to 3 weeks). Common side effects include blurred vision, dizziness or drowsiness, and dry mouth. It is not advised for those with an overactive thyroid, heart problems, or liver disease. Cyclobenzaprine is rated B by the FDA for safety during pregnancy, making it the safest muscle relaxant to use while pregnant.
- Dantrolene (Dantrium). Dantrolene helps control chronic spasticity related to spinal injuries. It is also used for conditions such as stroke, multiple sclerosis, and cerebral palsy. Dantrolene is taken as a capsule or intravenous powder for injection. Drowsiness and sensitivity to light are common side effects. It can cause severe liver problems, and should not be taken by people with active liver disease. The FDA has given dantrolene a C rating for safety in pregnancy.
- Metaxalone (Skelaxin, Metaxall, and Metaxall CP, Lorvatus PharmaPak). Metaxalone targets pain and muscle spasms from sprains, strains, and muscle injuries. It is available as a tablet or injection. Common side effects include drowsiness, dizziness, nausea, and vomiting. Metaxalone is generally not recommended for people with a known tendency to become anemic, and who have kidney or liver disease. Metaxalone may affect blood sugar tests for people with diabetes. The FDA has not rated metaxalone for safety during pregnancy.
- Methocarbamol (Robaxin, Robaxin-750). Methocarbamol eases acute muscle and bone pain. It can be taken as a tablet or by injection. Common side effects include dizziness, headache, nausea, flushing, and blurred vision. Methocarbamol is generally not recommended to people with renal disease or failure, or a history of allergic reaction to the medication. The FDA has given methocarbamol a C rating for safety during pregnancy.
- Orphenadrine. Orphenadrine is a medication used to relieve pain and stiffness caused by muscle injuries. It is available as an extended-release tablet. Common side effects include dry mouth, lightheadedness, difficult urination, heartburn, nausea and vomiting. It is generally not recommended to people with previous sensitivities to the ingredients, myasthenia gravis, those with glaucoma or certain types of ulcers. The FDA has given orphenadrine a C rating for safety during pregnancy.
- Tizanidine (Comfort Pac with Tizanidine, Zanaflex). Tizanidine is used to treat muscle spasms caused by spinal cord injuries and other conditions such as multiple sclerosis. Tizanidine is available in tablet and capsule form and absorbs differently depending on whether it is taken on an empty stomach or with food. Common side effects include dry mouth, dizziness, constipation and tiredness. It should not be used by people taking fluvoxamine or ciprofloxacin or those who have liver disease. Tizanidine is rated in the C category for safety during pregnancy.
Sometimes the first muscle relaxers a doctor prescribes does not work as well as expected. It may be necessary to try an alternative if the initial prescription is not effective. Many drugs interact with muscle relaxers and a person should keep their health care provider informed of all prescription and non-prescription medications he or she is taking.
There is very little research regarding which muscle relaxers are most effective, so the choice of which medication—or whether to use one at all—is based on factors such as a person’s reaction to the medication and personal preferences, potential for abuse, possible drug interactions, and adverse side effects.
How should muscle relaxants be taken?
These medicines are usually taken by mouth (tablets, capsules or liquids). In general, your doctor will start off with a low dose and increase this gradually over a number of weeks. This is in order to help your body get used to these medicines. Injections into the back are always started in the hospital.
Cannabis extract is a spray for the mouth. It should be sprayed under the tongue or on to the inside of the cheek once or twice a day. Always change the area in your mouth where you spray, to prevent irritation of the mouth. Like other muscle relaxants you will normally start off with a low dose. The number of sprays used is normally increased over a number of days.
What are the possible side-effects?
As with most medicines, muscle relaxants have a number of possible side-effects. However, not everyone experiences them and they usually improve as your body adjusts to the new medicine. Most muscle relaxants cause muscle weakness as a side-effect. It is not possible in this leaflet to list all the possible side-effects for these medicines. However, see below for a list of the most common side-effects. For more detailed information, see the leaflet that comes with the medicine packet.
- Baclofen – feeling sick, tiredness, drowsiness, problems with eyesight, weakness, dizziness, light-headedness, headache, dry mouth, breathing difficulties, aching muscles, sleeplessness or nightmares, feeling anxious or agitated, confusion, unsteadiness, increased need to pass urine, shakiness, increased sweating, and skin rash.
- Dantrolene – feeling dizzy, sleepy, tired, or generally unwell, diarrhoea, feeling or being sick, tummy (abdominal) pain, headache, loss of appetite, rash, speech or sight difficulties, high temperature (fever), chills, difficulty in breathing, seizures. It may also cause inflammation of the lining around the heart (sometimes with fluid in the lungs). Liver toxicity is also a possible side-effect of dantrolene.
- Diazepam – feeling sleepy, weak, or light-headed, forgetfulness, feeling confused or unsteady, feeling (or being) aggressive.
- Methocarbamol – forgetfulness, allergic reactions, being anxious, blurred vision, a slow heart rate, being confused or dizzy, headache, heartburn, feeling or being sick, itching, rash, and low blood pressure.
- Cannabis extract – feeling dizzy, depressed mood, diarrhoea or constipation, mouth ulcers or pain, feeling tired or sick, appetite changes. Hallucinations have also been reported.