Long-term use of skeletal muscle relaxants for chronic pain :- Medznat

With stricter opioid prescribing guidelines, the use of skeletal muscle relaxants (SMRs) for chronic pain has escalated. However, their long-term efficiency in tackling chronic pain remains unclear. Hence, this systematic review sought to determine the usefulness of long-term SMRs for chronic pain management.

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Key take away

When managing chronic pain, long-term use of skeletal muscle relaxants can be useful for painful spasms, cramps, and neck pain. But, their benefits are limited for headaches, fibromyalgia, and low back pain. Clinicians should remain vigilant, monitoring progress and adjusting treatment as necessary.

Background

Method

An extensive search of Web of Science, Ovid MEDLINE, CINAHL, Cochrane, and Embase (Ovid) was executed. Studies in English, Spanish, or Italian were incorporated. For chronic pain alleviation, only cohort studies and randomized clinical trials (RCTs) having comparator groups, examining SMR use for a minimum of one month were taken into consideration. Data analysis, risk-of-bias, and quality evaluation were carried out by two reviewers. Studies were categorized by chronic pain syndrome, including headaches, fibromyalgia, low back pain, painful cramps or spasticity, and others.

Result

Overall, 30 RCTs with 1,314 volunteers and 14 cohort studies with 1,168 volunteers were analyzed. Most studies were short-term (4-6 weeks). In total, 9 distinct SMRs were assessed, with Baclofen (11 studies, 25%), Tizanidine (8 studies, 18%), and Cyclobenzaprine (7 studies, 16%) being the most commonly evaluated. The strongest evidence for SMR efficiency was found for painful cramps, neck pain, and trigeminal neuralgia.

However, SMRs for fibromyalgia, low back pain, and other chronic pain conditions did not illustrate superior efficacy when compared to placebo. Dry mouth and sedation were the most frequently noted deleterious effects. The bias risk in RCTs was low to moderate. Furthermore, the quality of the cohort studies ranged from fair to good.

Conclusion

Long-term SMR use may be valuable for those with painful spasms, cramps, and neck pain, but offers limited benefit for ailments like low back pain, fibromyalgia, and headaches. Healthcare personnel must monitor for unwanted effects and contemplate medication withdrawal if pain management targets are not achieved.