Are Muscle Relaxants Safe for Back Pain?

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Back pain plagues many Americans, and new research shows that doctors are doling out muscle relaxant prescriptions to treat the pain — often along with an opioid painkiller.

Experts worry that muscle relaxants may not help much and could cause troubling side effects, especially in older patients.

The study found the rate of long-term prescriptions for muscle relaxants to treat back and other muscle pain tripled between 2005 and 2016.

Also concerning, nearly 70 percent of those prescribed muscle relaxants were given a prescription for an opioid pain-relieving medication like oxycodone (OxyContin) at the same time. Taking these medications together increases the potential risk of ill effects, the researchers said.

Skeletal muscle relaxants are approved for short-term treatment of muscle spasms and back pain. Examples of muscle relaxants include baclofen (Lioresal), carisoprodol (Soma), cyclobenzaprine (Fexmid) and tizanidine (Zanaflex).

Recommendations generally limit use of these drugs to a maximum of three weeks, since they have not been shown to work for muscle spasms beyond that time.

Experts say these medications can be very sedating. Serious side effects associated with their use include dizziness, falls, fractures, car accidents, dependence and overdose.

Muscle relaxants pose a significant risk to people over 65, and the American Geriatrics Society advises against their use in this age group.

Despite this recommendation, nearly a quarter of office visits for muscle relaxants in 2016 were for seniors, the study noted. This group makes up less than 15 percent of the general population.

The U.S. Food and Drug Administration cautions against using muscle relaxants and opioids together, noting the combination can cause difficulty breathing and death, according to background notes.

The study was based on national prescribing data from 2005 to 2016. The researchers looked at the total number of visits a year, what medications were prescribed and if the prescription was new or ongoing.

The most common reason people were taking muscle relaxants was to treat back problems.

Experts say the research didn’t look specifically at why doctors were prescribing these medications more, but he suspects there are at least a few factors driving the increase. One is that there aren’t really any good alternative drugs, so doctors may not want to take them away. Another is that patients may put some pressure on their doctor to treat their pain.

But skeletal muscle relaxants shouldn’t be considered a first-line treatment for back pain or muscle spasms, experts say. He said physical therapy and over-the-counter medications like Advil or Tylenol can help lessen the pain.