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Highlights of contraindications, adverse effects, and drug interactions for these drugs are listed in Many of the studies evaluating the effectiveness of skeletal muscle relaxants are hampered by poor methodologic design, including incomplete reporting of compliance, improper or no mention of allocation concealment, not utilizing intention-to-treat methods, and inadequate randomization.1718 Nonetheless, skeletal muscle relaxants have been evaluated in systematic reviews and meta-analyses.

Some evidence appears to support nonbenzodiazepine skeletal muscle relaxants, such as carisoprodol, cyclobenzaprine, orphenadrine (Norflex), and tizanidine (Zanaflex), for acute low back pain.1718 Randomized controlled trials involving metaxalone have not been conducted since the 1970s.

In general, all of the drugs were shown to have some benefit.18 The limitations of published comparison trials include using unvalidated scales to measure outcomes, involving small numbers of participants, and often not reporting adverse effects of studied medications. Cyclobenzaprine hydrochloride effect on skeletal muscle spasm in the lumbar region and neck: two double-blind controlled clinical laboratory studies.

One fair-quality study showed carisoprodol was better than diazepam at improving muscle spasm and global and functional status in patients with low back pain.30 Another fair-quality study comparing tizanidine with chlorzoxazone (Parafon Forte) for back spasms did not show any significant difference.31A different systematic review did include some studies which were considered to be high quality.17 These studies revealed no difference in outcomes (e.g., muscle spasms, muscle pain, tension, tenderness, functional status) among cyclobenzaprine versus carisoprodol; chlorzoxa-zone versus tizanidine; or diazepam versus tizanidine.17Although the evidence for effectiveness of skeletal muscle relaxants in musculoskeletal conditions is limited, strong evidence does exist in terms of toxicity.

Skeletal muscle relaxants are widely used in treating musculoskeletal conditions.

However, evidence of their effectiveness consists mainly of studies with poor methodologic design.

The placebo-controlled trials included 17 on cyclobenzaprine, six on tizanidine, four on carisoprodol, and four on orphenadrine, and were mostly conducted more than 15 years ago. Low-dose cyclobenzaprine versus combination therapy with ibuprofen for acute neck or back pain with muscle spasm: a randomized trial. Contact [email protected] copyright questions and/or permission requests.

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Systematic reviews and meta-analyses support using skeletal muscle relaxants for short-term relief of acute low back pain when nonsteroidal anti-inflammatory drugs or acetaminophen are not effective or tolerated.

Antispastic agents (e.g., baclofen [Lioresal], dantrolene [Dantrium]) should not be prescribed for musculoskeletal conditions because there is sparse evidence to support their use.