Do Muscle Relaxers Help Back Pain?

Written by Clay Smith

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There was no benefit in functional outcome or pain at one week by using ibuprofen + either baclofen, metaxolone, or tizanidine over ibuprofen + placebo.

Why does this matter?
A metaanalysis showed muscle relaxers may be marginally helpful for low back pain. But individual RCTs have shown no benefit for diazepam, orphenadrine or methocarbamol, or cyclobenzaprine. What about a head-to-head trial of several other agents compared to placebo? Surely one of these will help, right?

Time found to be most effective therapy for back pain
This was a multifactorial RCT with 320 patients randomized to ibuprofen + either placebo, baclofen, metaxolone, or tizanidine. For the primary outcome of improved functional disability at one week, there was no difference, nor was there improvement in pain with any of the active muscle relaxers compared to ibuprofen + placebo. Prescriptions for muscle relaxers may make me feel better, like I’m helping, but they don’t actually help the patient. It’s kind of a bummer.

A Randomized, Placebo-Controlled Trial of Ibuprofen Plus Metaxalone, Tizanidine, or Baclofen for Acute Low Back Pain. Ann Emerg Med. 2019 Apr 5. pii: S0196-0644(19)30139-8. doi: 10.1016/j.annemergmed.2019.02.017. [Epub ahead of print]

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Reviewed by Thomas Davis

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