Whether from a new injury or an aggravated old injury, stiffness, and soreness in the neck and back at night may lead to disrupted sleep and more pain in the morning. Muscle relaxants have been shown to help relieve this pain and get you through these challenging days.
Used at night, these medications may improve acute neck and back pain. These medications are highly effective in easing muscle tension, making muscles feel looser, and helping with spasms or contractions.
An estimated 2 million American adults reported muscle relaxants used in the U.S. However, Muscle relaxers are effective as a short-term treatment and not recommended for a much extended period due to the side effects observed, which are described further.
Muscle relaxants are medicines that help to reduce muscle spasms, which are involuntary muscle contractions caused due to spine-related issues, such as Fibromyalgia, low back strain, or whiplash. Often, muscle spasms cause severe pain and may limit your mobility.
Your doctor might prescribe a muscle relaxant to ease muscle spasms, reduce pain, and help your muscles move better. When your muscles move better, other spine pain treatments, such as physical therapy, stretching, and exercise, are more effective.
There are two types of muscle relaxers: Antispastics and Antispasmodics
Antispastics and antispasmodics have different indications and side effects. Since these drugs work differently, people should never use them interchangeably or substitute one type for another.
Muscle relaxers are effective short-term treatments and should be used to treat acute pain or injury caused by muscle spasms rather than chronic pain.
Individuals should not take muscle relaxants for more than two or three weeks unless directed by the concerned medical practitioner. Consuming it longer might increase the chances of falls, drug dependence, and abuse. Because of this risk, these medicines are not recommended for people over 65.
Some drugs are not muscle relaxants, but they can still help relieve symptoms of spasticity or muscle spasms. Off-label drugs for spasticity include Benzodiazepines (such as Lorazepam, Klonopin, and Alprazolam) and Gabapentin.
Off-label drugs for muscle spasms include NSAIDs (such as Naproxen and Ibuprofen), Acetaminophen, and Cannabis.
Muscle relaxers relieve tense muscles, contractions, and tissue stiffness by different methods. Two categories of muscle relaxers work slightly differently in the body:
The mechanism of skeletal muscle relaxants is categorized under spasmolytics. Other Neuromuscular means are tissue-related, such as muscle relaxers for menstrual cramps.
Spasmolytics relieve muscular tension by interacting with the GABA receptors as an agonist and acting on the CNS in various neurological disorders ensuing hyperpolarization of neurons, while the neuromuscular blockers interfere with chemical transmissions at the endplates. They don't affect the CNS.
Diazepam, Baclofen, Tizanidine, and methocarbamol act on the brain and spinal cord (CNS). Dantrolene works directly on the muscle and thus has lesser side effects than other muscle relaxants.
Because of this reason, this drug is often the first muscle relaxant to be prescribed for people with long-term muscle spasms. Cannabis extract works on the brain, spinal cord, and muscles.
The first-line treatment for an individual's back/neck pain or muscle spasms would be over-the-counter pain relievers like NSAIDs (Naproxen and Ibuprofen) or Acetaminophen. Research shows that a muscle relaxant added to Acetaminophen or an NSAID works better than either alone. Now, let's study about top 5 muscle relaxants-
It is a non-benzodiazepine drug, available with the brand name Soma in the U.S. Adults can take it to relieve acute, painful muscle conditions. It is a Schedule IV drug and has the potential to be abused. For this reason, you should not use it if you have a history of drug abuse.
Doctors can only prescribe it for a maximum of 3 weeks. There is insufficient evidence that it works for more extended periods. It may cause dizziness and drowsiness and should not be used in folks over 65.
Medical practitioners also warn people about the dangers of its combination with alcohol. In addition, there is a risk of developing a dependency on Carisoprodol. Its recommended dosage is 250-300 mg three times a day and at bedtime.
It is a non-benzodiazepine. Flexeril, Fexmid, and Amrix are brand names of this drug in the U.S. It can treat muscle spasms with acute muscle conditions when a person combines it with rest and physical therapy.
Cyclobenzaprine is available in two oral forms, i.e., immediate-release tablets and extended-release capsules. This drug is a reasonable first choice because it is a cheap generic, but its sedation side effect limits its daily use. It may also cause dry mouth, especially in older folks.
Other side effects include- confusion, irritability, headache, and dizziness. At the standard dose of 10 to 30 mg daily, Cyclobenzaprine will make you sleepy. If you take it during the day, you can reduce it to half and take 5 mg to reduce drowsiness.
Diazepam is a benzodiazepine. Diastat and Valium are common brand names of this drug in the United States. Healthcare providers may prescribe oral or parenteral Diazepam for severe muscle spasms and spasticity associated with neurological disorders.
However, these aren't most recommended because they are highly sedating, don't work well, and Diazepam can be addictive. Other side effects include drowsiness, weakness or lightheadedness, forgetfulness, feeling confused or unsteady, and feeling (or being) aggressive. Avoid benzodiazepines for back and neck pain because there are much better options.
Based on clinical studies, this drug is taken as 210 mg orally three or four times daily. This drug has the fewest reported side effects and the lowest sedation potential of the muscle relaxants at this dose. If an individual requires Diazepam injections, the concerned doctor may prescribe an initial IV dose of 5-10 mg and another dose 34 hours later.
Metaxalone is a non-benzodiazepine. Physicians prescribe Metaxalone in combination with others, physical therapy, and other non-drug treatment strategies for painful muscle conditions. A common brand name of this drug is Skelaxin in the U.S.
Insurance companies don't like to cover it because it is high priced, and cheaper alternatives are available. The side effects of Metaxalone may include dizziness, drowsiness, headache, irritability, and upset stomach. People cannot take it with drugs that affect the amount of serotonin in the body due to the risk of serotonin syndrome.
Taken as 800 mg tablets 3 to 4 times a day, this drug has the fewest reported side effects and lowest sedation potential of the muscle relaxants based on clinical studies. Simply put, it is the best-tolerated muscle relaxant.
It is an OTC non-benzodiazepine, antispasmodic medication. A common brand name for it in the U.S. is Robaxin. People usually take this drug orally, but doctors can prescribe IV or intramuscular forms.
In recent studies where it was used for up to 8 days, 44% of people who took this drug had complete pain relief (compared to 18% who took nothing) without any severe side effects.
However, side effects of Methocarbamol may include forgetfulness, allergic reactions, being anxious, headache, blurred vision, a slow heart rate, being confused or dizziness, heartburn, feeling or being sick, itching, rash, and low blood pressure.
Taken as needed, 1500 mg every 6 to 8 hours is a cheap and well-tolerated option for people suffering from acute neck and back pain. Try this first, as it is less sedating than other options, like Cyclobenzaprine and Carisoprodol.
Muscle relaxants do not act like over the counter sleeping medication, they directly act on the muscles, and these muscle relaxants also target the brain and spine nerves. Therefore, you are only expected to feel tired when using these drugs.
Muscle tiredness occurs when your muscles don't have enough strength. Consequently, your muscles might not move or contract easily as they usually do. Some chronic medical conditions may cause your muscles to wear out and cause fatigue. Moreover, in some cases, an infection can cause your muscles to falter.
Good muscle relaxers are usually used for a few days before you being noticing their effects. Your prescription can go up to three weeks, depending on the severity of your pain.
Many individuals who use muscle relaxants don't generally know when to take these drugs. You must know when to take a muscle relaxer to avoid inconveniences. Suppose you use a muscle relaxer around the clock. It would be best to take it in the evening when you have few distractions and can relax more.
Some muscle relaxers cause more sleepiness and drowsiness than others. Preparing yourself for that and any other drug side effects don't hurt. You are not recommended to use the drug when driving or handling other machines.
That is why early evenings are the best times to take muscle relaxers. The drowsiness distracts you from the pain and gives you some needed rest.
Several factors may be responsible for any medicine's delayed or immediate potency. But, usually, the time it takes for muscle relaxants to kick in may hinge on differentials such as age, weight, body fat, any medical condition, and others. It takes around 30 minutes or more after its administration.
Peak efficacy may linger around 2 to 4 hours. When these medicines are taken orally, they disintegrate and enter the bloodstream, then are distributed to various tissues, organs, and CNS. The progression might take up to 30 minutes before results are experienced.
In many cases, they may last for about 12 hours or more. Sometimes, delayed efficacy may be due to factors only a medical doctor can understand. At this point, taking more doses of the medication is inadvisable since it may result in an overdose of muscle relaxants.
Intravenous drugs provide the shortest administration route as they go directly into the bloodstream and become effective in less than 10 minutes.
The below table provides further details of some muscle relaxants:
72 hours for regular doses
48 hours (Up to 10 days with high doses)
48 to 72 hours
2-3 days, Variable (Chronic / Acute)
up to 4 hours
Up to 10 days
4 to 4 days
3 to 10 days
An assumption was made that the efficacy of skeletal muscle relaxants causes some degree of sedation/drowsiness. To test this hypothesis, they conducted a posthoc analysis of the pooled data from two identical, double-blind, randomized, placebo-controlled, parallel-group studies in patients with acute, painful muscle spasms.
Subjects/Patients were randomized to receive Cyclobenzaprine extended-release (CER) 15mg and CER 30mg once daily or placebo. Patients recorded daily assessments of daytime sleepiness.
On Day 4, patients were stratified into two categories based on the reported daytime drowsiness"little to none" or "some to extreme." They were assessed for an efficacious positive response, defined as good to excellent improvement on the patient rating of medicine helpfulness on Day 4.
In the group of CER, 15mg, out of 59 people with little to no drowsiness, 32 patients (54%) reported sound effects, noted by 33 of 57 of those (58%) who had shown some extreme tiredness. In the group of CER 30mg, out of 50 patients with little to no drowsiness, 27 reported (54%) good to excellent medication helpfulness, as did 41 of 70 (59%) with some extreme tiredness.
Healthcare professionals recommend muscle relaxers for certain people with spasms and muscle pain. These drugs can provide short-term relief but can also cause side effects. Adverse side effects include:
Since these side effects can impair or disorient you, you should not drink alcohol while taking them and avoid driving, especially until you know how they affect your coordination. Often, these medications work quickly, within 30 minutes, and you will feel the effects for four to six hours, depending on your dose and tolerance.
Muscle relaxants such as Diazepam and Carisoprodol can be habit-forming. Make sure you take your medicine exactly as prescribed by your healthcare professional.
Muscle relaxers are effective short-term solutions for relieving spasms and muscle pain but can cause some side effects. Along with acting directly on the muscles, muscle relaxers also target the brain and spine nerves.
It is common for you to feel tired or exhausted while taking these drugs. The best option depends on the injury or underlying condition and factors such as current medications and the person's age.
There are risks involved in taking prescription or OTC muscle relaxers. Consult a pharmacist or medical practitioner first and follow the instructions closely.
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