In this post we’ll take a quick look at some of the more commonly prescribed muscle relaxants for neck pain and back pain, discuss their uses, side-effects, and possible interactions, and offer brief guidance on staying safe when using muscle relaxants for chronic pain.
Neck Muscle Pain Diagnosis
When discussing the possibility of using muscle relaxants for chronic neck pain your physician should have already ruled out structural abnormalities in the neck anatomy, along with neurological issues, or other clear (non-muscular) cause of the neck pain. In some cases muscle relaxants are warranted in order to address a painful muscle spasm resulting from an acute strain with no other identifiable cause. Determining the origin of neck pain may involve MRI or CT scans, X-Rays, physical examination, and detailed medical history. It may be that by discussing recent activities the trigger for the neck pain can be isolated, such as a day of gardening after many weeks off over winter, or a recent dance lesson, canoe trip, or simply having a seat in the front row at the cinema.
Stiff Neck Pain Treatment
The onset of severe neck pain can cause you to avoid physical activity but, unfortunately, most muscular neck pain will become worse with inactivity leading instead to a stiff neck and further pain. Gentle neck stretches can help loosen stiff muscles and the application of heat therapy can also help relax the area. If the neck feels inflamed and looks red then heat should not be applied. Applying ice to a stiff and painful neck may cause further muscle spasms and tightness so, unless there is a specific trauma to the neck causing inflammation, it is unwise to use ice to treat neck pain. It is important to seek proper medical attention when dealing with any sudden onset of severe neck pain and stiffness in order to rule out serious, life-threatening conditions such as meningitis. Your doctor may prescribe you muscle relaxants if the neck stiffness appears muscular and unresponsive to stretching, or other relaxation techniques such as massage or heat therapy.
Common Muscle Relaxers
Cyclobenzaprine (Flexeril) is a common muscle relaxant that your doctor may prescribe for chronic pain management. This drug is, however, a tricyclic antidepressant medication that failed its trials as an antidepressant and was redeveloped as a muscle relaxant. Patients should be aware of its history as an antidepressant and physicians should be cautious over its use when their patient is already on other medications that could interact with Flexeril/Amrix. Side-effects of this medication are similar to the drug amitriptyline (another antidepressant) and include a risk of sudden cardiac death, drowsiness/sedation, and anticholinergic effects affecting the muscles throughout the body, not just the neck.
Are Muscle Relaxants Addictive?
Known as Soma, carisoprodol is another muscle relaxant commonly prescribed in the US, despite it being banned by the European Medicines Agency. They banned Soma on the basis of concerns over physical and emotional addiction to the drug. A metabolite of carisoprodol is meprobamate, a hypnotic sedative that was found to be abused when marketed as Miltown years ago. The prescribing of Soma requires careful consideration therefore, with many more doctors each year deciding to opt for less controversial muscle relaxants to help patients with chronic pain management.
Popular Muscle Relaxants
An example of an over-the-counter muscle relaxant with less likelihood of inducing a sedative effect is methocarbamol, also known as Robaxin, or Robaxacet when combined with acetaminophen for added pain relief. Robaxin is similar to metaxalone (Skelaxin), and both are several decades old and a popular choice for physicians to prescribe for stiff neck pain. These muscle relaxants can still cause sedation and do have other side-effects to consider, such as liver toxicity.
Norflex and Sedation
Norflex (orphenadrine) is another commonly prescribed muscle relaxant for stiff neck pain but patients should be aware that this is a drug which is similar to Benadryl both in terms of activity and mechanism of action. Norflex is a diphenhydramine and, therefore, has a similar set of side-effects to such drugs. The sedative effects and impairment of motor control are comparable to the effects of drinking alcohol which makes them unsuitable for those needing muscle relaxants whilst at work, when driving, or when looking after children, for example.
Unofficial Muscle Relaxants
Two drugs that are often used as muscle relaxants are not in fact approved for such use by the FDA. These are tizanidine (Zanaflex) and baclofen (Lioresal), both of which are approved for spasticity but not as muscle relaxants. Tizanidine was found, in a study two decades ago, to be effective in reducing acute low back pain and musculoskeletal pain in combination with ibuprofen, making it a popular, unofficial, choice for patients and their physicians when coping with stiff neck pain. Zanaflex is an alpha-adrenergic drug with similarities to clonidine, making it unsuitable for some patients but preferred for many as a bedtime muscle relaxants that does not cause a drowsy hangover effect the next morning. Baclofen also has a sedative effect and so is not suitable for those needing to take medication for a stiff neck during the day whilst at work.
Alternative Remedies for Stiff Neck Pain
Patients wishing to avoid prescription or over-the-counter neck pain remedies may want to try topical treatments such as a muscle rub with rosemary and cayenne, both of which aid circulation to the muscles. These types of natural neck pain relief products can help the muscles relax and are popular with athletes for post workout rubdowns. Acupressure mats draped over a rolled-up towel can also help with neck pain and stiffness, as can acupuncture and massage. It is important to discover the cause of your neck pain before applying treatment however in order to rule out a neurological issue, structural anomaly in the neck anatomy, or other cause that could be exacerbated by the use of muscle relaxants for stiff neck pain.