Dr. Nathan Kadlecek, PT
Is a physical therapist committed to providing high quality health information, largely focused on lower back pain and the gross overuse of diagnostic imaging, medication, surgery, low quality treatment methods, and the over-diagnosis of pain conditions. He's also a powerlifter, pain nerd, macro-scale thinker, and wants to help you think differently about pain, healthcare, and life.
Have you ever used muscle relaxers for lower back pain or sciatica? In this video I dive into when they may be appropriate to use, when they are not appropriate to use, and what to look out for. This video is going over a systematic review (a review of many research papers) of the proper use-cases of muscle relaxers.
"Skeletal muscle relaxants are effective agents used for the management of acute nonspecific low back pain. However, the risk of adverse drug events raises concern for their safety in routine use. In the past decade, the overuse of some agents has grown drastically, with an increased incidence of adverse effects. In addition to sedation, patients may experience headache, dizziness, blurred vision, nausea, and vomiting.
The potential for abuse and dependency seen with carisoprodol resulted in its reclassification as a controlled substance in 2012 by the DEA. Ideally, this agent should be used with caution due to lack of efficacy, abuse potential, and risk for active metabolite accumulation.
The medications in this class are commonly used to treat acute musculoskeletal back pain, but they are often taken in higher quantities and for longer durations than recommended. Since evidence supports their use only for acute low back pain, they should be used temporarily for pain relief. This also prevents the extended masking of any underlying condition causing the back pain.
There are no set guidelines as to which agents are preferred; therefore, clinical judgment with proper understanding of the drug characteristics and patient-specific parameters should guide appropriate drug selection.6 Health care providers must use their judgment to weigh the pros and cons of prescribing a muscle relaxant while tailoring therapy to the individual needs of each patient. As evidence improves, recommendations can be modified, allowing patients to achieve safe and effective relief of their acute low back pain."
Witenko C, Moorman-Li R, Motycka C, et al. Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain. P T. 2014;39(6):427-435.