According to a new study, muscle relaxant medications are largely ineffective for treating lower back pain, despite their widespread use.
The study’s findings have been published in the journal ‘The BMJ’. The study’s findings indicated that muscle relaxants may temporarily alleviate pain, but the effect is too small to be considered clinically significant, and there is an increased risk of adverse effects.
The researchers stressed that the evidence is inconclusive and that large trials are urgently needed to dispel doubts about the use of these drugs for back pain.
Lower back pain is a major public health problem worldwide, and muscle relaxants (a broad class of medications that includes non-benzodiazepine antispasmodics and antispasmodics) are a frequently prescribed treatment.
For example, in 2020, prescriptions in England will exceed 1.3 million, while prescriptions in the United States will exceed 30 million. Nonetheless, clinical practise guidelines worldwide make contradictory recommendations regarding their use.
To address this, researchers in Australia examined the effectiveness, acceptability, and safety of muscle relaxants in adults with non-specific low back pain when compared to placebo, usual care, or no treatment.
They reviewed and analysed evidence from 31 randomised controlled trials involving over 6,500 participants that were published between February 2016 and February 2021.
Although the trials were of varying quality, the researchers were able to grade the evidence’s certainty using the widely accepted GRADE system.
They defined the smallest clinically significant effect as a difference of at least 10 points on a 0-to-100-point scale between pain and disability – a threshold used in previous low back pain studies.
Very low certainty evidence indicated that non-benzodiazepine antispasmodic drugs may reduce pain intensity in patients with acute low back pain by two weeks or less when compared to controls. However, this effect is small – less than 8 points on a 0-100-point scale – and falls short of commonly accepted clinically meaningful thresholds.
Non-benzodiazepine antispasmodics had little to no effect on pain intensity at 3-13 weeks or on disability at all follow-up time points.
Additionally, evidence of low and very low certainty indicated that non-benzodiazepine antispasmodics may increase the risk of adverse events (most frequently, dizziness, drowsiness, headache, and nausea) and have little to no effect on treatment discontinuation when compared to controls.
No trials have been conducted to determine the long-term effects of muscle relaxants.
Although the researchers based their analysis on the best available trial evidence, they acknowledged some limitations and stated that the modest overall effect may still mean that some, but not all, individuals benefit.
They did emphasise, however, that the evidence’s low to very low certainty precludes making any firm recommendations.
“We would encourage clinicians to discuss the uncertainty surrounding the efficacy and safety of muscle relaxants with patients, educating them about the possibility of a worthwhile benefit in pain reduction but an increased risk of experiencing a non-serious adverse event,” they wrote.
“Importantly needed are large, high-quality, placebo-controlled trials to resolve uncertainties about the efficacy and safety of muscle relaxants for low back pain,” they concluded.
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