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Yury Bayarski asked:

Muscle relaxants are one of the many treatments used in the management of low back pain. About thirty-five percent of patients visiting a physician for low back pain are prescribed skeletal muscle relaxers.

For acute low back pain, muscle relaxaers improve pain, muscle tension, and mobility more effectively than a placebo does. For chronic low back pain, they may relieve pain and lead to overall improvement. However, side effects are common.

A muscle relaxant is a drug which affects skeletal muscle function and decreases the muscle tone. It may be used to alleviate symptoms such as muscle spasms, pain, and hyperreflexia. The term “muscle relaxant” is used to refer to two major therapeutic groups: neuromuscular blockers and spasmolytics. Neuromuscular blockers act by interfering with transmission at the neuromuscular end plate and have no CNS activity. They are often used during surgical procedures and in intensive care and emergency medicine to cause paralysis. Spasmolytics, also known as “centrally-acting” muscle relaxants, are used to alleviate musculoskeletal pain and spasms and to reduce spasticity in a variety of neurological conditions. While both neuromuscular blockers and spasmolytics are often grouped together as muscle relaxants

The term “muscle relaxants” is very broad and includes a wide range of drugs with different indications and mechanisms of action. Muscle relaxants can be divided into two main categories: antispasmodic and antispasticity medications.

Antispasmodics are used to decrease muscle spasm associated with painful conditions such as back pain. Antispasmodics can be subclassified into benzodiazepines and nonbenzodiazepines. Benzodiazepines (e.g., alprazolam, diazepam, tetrazepam) are used as anxiolytics, sedatives, hypnotics, anticonvulsants, and skeletal muscle relaxants.

Non-benzodiazepines include a variety of drugs that can act at the brain stem or spinal cord level. The mechanisms of action with the central nervous system are still not completely understood.

Carisoprodol and metaxalone have moderate antispasmodic effects and are mildly sedative. Carisoprodol blocks interneuronal activity in the descending reticular formation and spinal cord. Carisoprodol is metabolized to meprobamate. Meprobamate was introduced as an antianxiety agent in 1955 and is prescribed primarily to treat anxiety, tension, and associated muscle spasms. Its onset and duration of action are similar to the intermediate-acting barbiturates. Excessive use can result in psychological and physical dependence.

Cyclobenzaprine is structurally similar to the tricyclic antidepressants; however, it has strong side effects such as sedation. It is currently believed that cyclobenzaprine acts in the brain stem rather than at the spinal cord level. Cyclobenzaprine has anticholinergic activity (which is responsible for some side effects such as dry mouth).

The use of muscle relaxants for low back pain continues to be a source of controversy among physicians, mainly because of their side effects. In addition to sedation, potential side effects include drowsiness, headache, blurred vision, nausea, and vomiting. Potential for abuse and dependency has also great drawback. Some guidelines recommend these medications alone or in combination with NSAIDs as optional, others clearly do not recommend using these drugs. Despite this controversy, 91% of doctors report using muscle relaxants even if they are conditionally discouraged by guidelines.

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