Long-Term Use of Muscle Relaxant Medications for Chronic Pain: A Systematic Review

Alex Haga — Wed, 25 Sep 2024 13:18:36 +0000

Date Added:

September 25, 2024

Journal/Publication:

JAMA Network Open

Publication Date:

September 19, 2024

Issue:

Volume:

URL:

Long-Term Use of Muscle Relaxant Medications for Chronic Pain: A Systematic Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2024.34835

Keywords

chronic pain

muscle relaxants

PMID (1):

39298168

MeSH

Chronic Pain* / therapy

Muscle Relaxants

Central / therapeutic use

Humans

Aside from a few specific indications, muscle relaxants do not benefit patients with chronic pain. James W. Mold, MD, MPH

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Importance: Stricter opioid prescribing guidelines have increased prescriptions of skeletal muscle relaxants (SMRs) for chronic pain, but the efficacy of long-term use of SMRs for chronic pain is unknown.

Objective: To systematically review the effectiveness or efficacy of long-term use of SMRs for chronic pain.

Evidence review: Two reviewers systematically searched Ovid MEDLINE, Embase (Ovid), Web of Science, CINAHL, and Cochrane through December 4, 2023. They included articles published in English, Spanish, or Italian. Only randomized clinical trials (RCTs) and cohort studies with comparator groups evaluating at least 1-month duration of SMRs for chronic pain were included. The reviewers dually reviewed data abstraction, risk-of-bias, and quality. They characterized studies by chronic pain syndrome: low back pain, fibromyalgia, headaches, painful cramps or spasticity, and other syndromes.

Findings: A total of 30 RCTs with 1314 participants and 14 cohort studies with 1168 participants assessed SMRs for chronic pain. Studies were primarily short-term (4-6 weeks). Nine unique SMRs were represented by the studies identified. Eleven studies (25%) examined baclofen, 8 (18%) examined tizanidine, and 7 (16%) examined cyclobenzaprine. Evidence for effectiveness was strongest for SMRs used for trigeminal neuralgia, neck pain, and painful cramps; evidence suggested SMRs for fibromyalgia, low back pain, and other syndromes were not more beneficial than placebo. The most common adverse effects were sedation and dry mouth. RCTs had a low to moderate risk of bias, and the quality of cohort studies was fair to good.

Conclusions and relevance: In this systematic review of long-term use of SMRs for chronic pain, findings suggest that their long-term use may benefit patients with painful spasms or cramps and neck pain; their long-term use for low back pain, fibromyalgia, and headaches did not appear to be beneficial. Clinicians should be vigilant for adverse effects and consider deprescribing if pain-related goals are not met.

Author/s:

Benjamin J Oldfield, Brynna Gleeson, Kenneth L Morford, Zoe Adams, Melissa C Funaro, William C Becker, Jessica S Merlin

Multimodal non-invasive non-pharmacological therapies for chronic pain: mechanisms and progress

Rowan Hutchins — Sun, 08 Oct 2023 05:00:00 +0000

Date Added:

October 8, 2023

Journal/Publication:

BMC Medicine

Publisher:

BMC

Publication Date:

September 29, 2023

Issue:

372

Volume:

URL:

Multimodal non-invasive non-pharmacological therapies for chronic pain: mechanisms and progress

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1186/s12916-023-03076-2

Keywords

chronic pain

PMID (1):

37775758

MeSH

Clinical Protocols

chronic disease

Chronic Pain* / therapy

A lengthy review of nonpharmacologic treatments for chronic pain including proposed mechanisms and current evidence. James W. Mold, MD, MPH

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Chronic pain conditions impose significant burdens worldwide. Pharmacological treatments like opioids have limitations. Non-invasive non-pharmacological therapies (NINPT) encompass diverse interventions including physical, psychological, complementary and alternative approaches, and other innovative techniques that provide analgesic options for chronic pain without medications.
Main body

This review elucidates the mechanisms of major NINPT modalities and synthesizes evidence for their clinical potential across chronic pain populations. NINPT leverages peripheral, spinal, and supraspinal mechanisms to restore normal pain processing and limit central sensitization. However, heterogeneity in treatment protocols and individual responses warrants optimization through precision medicine approaches.
Conclusion

Future adoption of NINPT requires addressing limitations in standardization and accessibility as well as synergistic combination with emerging therapies. Overall, this review highlights the promise of NINPT as a valuable complementary option ready for integration into contemporary pain medicine paradigms to improve patient care and outcomes.

Author/s:

Shi, Yu, Wu, Wen