10 In this cross-sectional prevalence study, the authors concluded that approximately two million U.S. usage patterns using data from the third National Health and Nutrition Examination Survey (NHANES III). IMS Health data from 2003–2004 showed carisoprodol, cyclobenzaprine, and metaxalone accounted for more than 45% of all prescriptions written for the management of musculoskeletal pain. Some clinicians would agree that the medications in this class tend to be used more frequently than necessary, but clear data are lacking. Recent literature analyzing the prevalence of muscle relaxant use is scarce. 8 Given the frequency of use, the questionable role in the treatment of back pain, and the potential for misuse, it is imperative for clinicians to be aware of the facts regarding commonly used muscle relaxants in the United States.ĮVIDENCE FOR THE USE OF SKELETAL MUSCLE RELAXANTS 8 For example, patients receiving cyclobenzaprine were more likely to report symptomatic improvement at two weeks compared with placebo (number needed to treat = 3).
2, 6, 7 Patients are often prescribed these agents for the treatment of acute back pain, and many experience relief within several weeks of starting therapy. Although they are not recommended as primary treatment, 35% of patients are prescribed muscle relaxants for nonspecific low back pain, and 18.5% receive initial muscle relaxant therapy. In general, muscle relaxants are controversial alternatives that have efficacy in nonspecific back pain but carry risks of adverse effects and increased cost. 1 After failure of a first-line agent, skeletal muscle relaxants, benzodiazepines, and opioids may be initiated based on evidence of temporary additional pain relief. This recommendation is primarily due to the favorable side-effect profile of these agents compared with other options as opposed to superior efficacy. The American Pain Society and the American College of Physicians published guidelines in 2007 for low back pain, recommending acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line treatment for most patients. 4 However, a significant portion of patients may experience persistent back pain well beyond the acute episode, affecting health care costs and limiting daily activities.
1 Nonspecific low back pain is primarily acute without an identifiable cause and typically resolves in less than four weeks. The three main classifications of low back pain include: nonspecific low back pain, back pain associated with radiculopathy or spinal stenosis, and back pain correlated with another specific spinal cause (i.e., malignancy, infection, or vertebral fracture). 1 – 3 However, there is little consensus on a proper diagnosis and optimal treatment strategy for these patients. For the past three decades, low back pain has consistently been ranked among the top five most common reasons for physician visits in the United States.
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