No Evidence Muscle Relaxers Ease Low Back Pain

By Alan Mozes
Health Day reporter

FRIDAY, July 9, 2021 (HealthDay News) – Although tens of millions of Americans are turning to muscle relaxers for lower back pain, a new Australian review finds little evidence that such drugs actually work.

This is the conclusion of a deep dive into 31 previous investigations, which have collectively enrolled more than 6,500 patients with lower back pain. The patients enrolled had treated lower back pain with a wide range of 18 different prescription muscle relaxants.

But while studies suggest that muscle relaxers may provide short-term pain relief, “on average, the effect is probably too small to be great,” said study author James McAuley. “And most patients wouldn’t feel any difference in their pain compared to taking a placebo or a sugar pill.”

Another concern: beyond their ineffectiveness, “there is also an increased risk of side effects,” warned McAuley, director of the Center for Pain IMPACT at the School of Health Sciences at the University of New South Wales in Sydney.

These side effects may include dizziness, drowsiness, headache and / or nausea, in addition to the risk that patients will develop a persistent addiction.

McAuley said his team was surprised by the results, “because previous research suggested that muscle relaxers reduce the intensity of pain. But when we included all of the more recent research, the results became much less certain. “

One problem is that much of the research “hasn’t been done very well, which means we can’t be very sure of the results,” McAuley said.

For example, none of the studies explored the use of long-term muscle relaxants. This means that the Australian team could only assess the effectiveness of the muscle relaxant over two time periods: throughout an initial two-week regimen and between 3 and 13 weeks. In the first case, they found weak evidence of insignificant benefit for pain relief; in the second case, they found no pain intensity or disability relief benefit.

McAuley’s takeaway: “There is a clear need to improve the way research is done on low back pain, so that we better understand whether drugs can help people or not.

“Low back pain is extremely common. It is experienced by 7% of the world’s population at some time. Most people, around 80%, will have at least one episode of low back pain in their lifetime,” noted McAuley.

But because it is often very difficult to isolate a specific cause, many treatments – including NSAIDs, opioids, exercise therapy, and / or counseling – aim to control pain rather than cure. . Muscle relaxants – prescribed to 30 million Americans in 2020 – fall into this category, McAuley said.

Since muscle relaxants provide no cure or 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.

In the meantime, McAuley says a movement is underway to “demedicalize” the treatment of lower back pain by adopting 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 noted, “and they should try to be active and continue with their usual activities, including work, as much as they are. they can.

“People with recent low back pain should receive low back pain counseling and education,” McAuley added. “[And] they need to be reassured that they do not have a serious illness and that their low back pain is very likely to improve over time, whether or not they take medication or other treatments. “

He and his colleagues shared their findings in the July 7 issue of BMJ.

“The problem is, back pain has so many causes,” said Dr. Daniel Park, associate professor in the department of orthopedics at the William Beaumont School of Medicine at Oakland University in Rochester, Michigan.

So when it comes to treatment, “there is no one size fits all,” said Park, who is also a spine surgeon at Beaumont-Royal Oak Hospital.

Still, Park believes that when it comes to muscle relaxants, “there is probably room for short-term benefit in helping patients manage severe pain.”

For example, he suggests that patients suffering from a “muscle slap from excess pressure” or those with a herniated disc might actually benefit from a short-term muscle relaxant.

But what about patients with garden-type back pain from a degenerative disc? Not really.

Either way, long-term pain relief is unlikely, regardless of the source of the problem, Park noted.

“In the long term, therapy and core strengthening will be much more beneficial,” said Park, while every effort should be made to identify the specific cause and minimize the risk of chronic disease, permanent damage and discomfort. sustainable.

More information

There is more on back pain at the US National Institute of Neurological Disorders and Stroke.

SOURCES: James McAuley, PhD., Director, Center for Pain IMPACT, School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia, and principal investigator, Neuroscience Research, Randwick, Australia; Daniel Park, MD, associate professor, department of orthopedics, Oakland University William Beaumont School of Medicine and spine surgeon, Beaumont Hospital-Royal Oak, UnaSource Surgery Center, Oakland Regional Hospital, Rochester, Michigan; BMJ, July 7, 2021

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