Why more doctors are prescribing muscle relaxers

As the opioid crisis continues in America, more doctors are steering away from prescribing opioid medications for pain, instead giving their patients muscle relaxers.

In 2021, 106,699 drug-involved overdose deaths were reported in the United States, up from 91,799 the year before and 70,630 in 2019. Opioids are involved in about eight of 10 overdose deaths, according to the U.S. Centers for Disease Control and Prevention.

In recognition of the toll the opioid crisis has taken, some doctors are prescribing muscle relaxers rather than opioids because they pose fewer risks and present less chance of dependency.

“Opioids are being scaled back considerably, and muscle relaxers are often recommended as a safer alternative, so long as they are not abused and are used as prescribed,” says Dr. Jesse Bracamonte, a family medicine physician with the Mayo Clinic Health System in Phoenix.

But muscle relaxers might not work as well as other medications and still pose some health risks.

What are muscle relaxers?

Muscle relaxers, also called muscle relaxants, are prescription medications that affect muscle function and are used to treat musculoskeletal pain and muscle spasms.

“Muscle relaxers belong to a rather wide range of medications with the design to provide patients with relief from muscle spasms or muscle spasticity,” says Dr. Trevor Rich, a family medicine physician in the Mayo Clinic Health System in Mondovi, Wisconsin.

There are two main types of muscle relaxers: antispastics and antispasmodics.

Approved medications in the antispasmodics group include carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol and orphenadrine.

Approved medications in the antispastics group include baclofen and dantrolene.

Two muscle relaxers, tizanidine and diazepam, have both antispastic and antispasmodic properties.

Some generic medications in each class have multiple brand names. Diazepam, for instance, is the generic name for Valium.

Each generic drug works in varying ways ,with different advantages and disadvantages.

What do muscle relaxers do?

Muscle relaxers typically are taken orally “to relieve pain, spasm and stiffness of skeletal muscles by depressing the central nervous system,” says Dr. Christopher Gharibo, director of pain management for NYU Langone Health. “They work in different parts of the central nervous system by altering the neurotransmitters that are responsible for communicating impulses to the skeletal muscles.”

Muscle relaxers sometimes are prescribed to relieve muscle-related pain and, as a result, help people sleep better when taken at night.

“Some muscle relaxants can also be beneficial in certain headache conditions or even neurological pain,” Gharibo says.

Rich says there have been “well-designed, systematic reviews of these prescriptions” spanning more than two decades and that the research has “provided high-quality evidence illustrating these medications are more effective than placebo for short-term relief of muscle spasms, primarily low back pain.”

Still, Bracamonte says the medications don’t work for everyone. Some people report only limited relief.

“I often prescribe my patients muscle relaxers to use along with other treatment options, including surface remedies, to maximize their combined effectiveness,” he says.

When might you use a muscle relaxer?

Rich notes “that all medications have side effects, and no medication is risk-free.”

That’s why muscle relaxers must be prescribed by physicians, so there can be “informed and shared decision-making with the patient” and “anticipated benefits, potential adverse effects, and expected response,” can be ascertained, Rich says.

Side effects of muscle relaxers?

The most common side effects of muscle relaxers is that they can cause extreme drowsiness in some people.

“For this reason, physicians will often caution patients to not drive or operate machinery while on therapeutic dosing,” Rich says.

In some cases, muscle relaxers can be habit-forming, Bracamonte says.

And they also can cause “poor focus, dry mouth and liver-enzyme elevation and low blood pressure,” Gharibo says.

Dr. Adam Tenforde, director of running medicine for Mass General Brigham in Boston, says some people also have reported difficulty concentrating and says muscle relaxers can interact with other medications.

“Muscle relaxers should be used with caution — especially for those already taking medications that act on the central nervous system,” Tenforde says. “And you should avoid drinking alcohol while taking them, as this can cause excessive sedation.”

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