Everything to know about muscle relaxers: Opioids, overdoes and safety
As the opioid crisis continues in America, more and more doctors are steering away from prescribing opioid medications as a treatment for pain. Since 1999, more than 932,000 people have died from a drug overdose, with annual rates steadily increasing. In 2021, for instance, 106,699 drug-involved overdose deaths were reported in the U.S., up from 91,799 the year before and 70,630 in 2019. Opioids are involved in about eight out of 10 overdose deaths, per the Centers for Disease Control and Prevention.
To combat the surge, some doctors are choosing to prescribe muscle relaxers in place of opioids because they pose fewer risks and less chance of dependency. "Opioids are being scaled back considerably and muscle relaxers are often recommended as a safer alternative, so long as they are not abused and are used as prescribed," says Jesse Bracamonte, MD, DO, a family medicine physician in the Mayo Clinic Health System in Phoenix, Arizona.
But muscle relaxers may not work as well as other medications and still come with some health risks of their own.
What are muscle relaxers?
Muscle relaxers, or muscle relaxants, are prescription medications that affect one's muscle function and are used to treat musculoskeletal pain and muscle spasms. "Muscle relaxers belong to a rather wide range of medications with the design to provide patients with relief from muscle spasms or muscle spasticity," explains Trevor Rich, MD, a family medicine physician in the Mayo Clinic Health System in Mondovi, Wisconsin.
There are two major drug classes of muscle relaxers: antispastics and antispasmodics. Approved medications in the antispasmodics group include carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol and orphenadrine. Approved medications in the antispastics group include baclofen and dantrolene. Two muscle relaxers, tizanidine and diazepam, have both antispastic and antispasmodic qualities. Some generic medications in each class have multiple brand names (diazepam is the generic name for Valium®, for instance,) and each generic drug works in varying ways with different advantages and disadvantages.
What do muscle relaxers do?
Muscle relaxers are typically taken orally, "to relieve pain, spasm and stiffness of skeletal muscles by depressing the central nervous system," explains Christopher Gharibo, MD, director of pain management at NYU Langone Health. "They work in different parts of the central nervous system by altering the neurotransmitters that are responsible for communicating impulses to the skeletal muscles," he adds.
Muscle relaxers are sometimes prescribed to relieve muscle-related pain symptoms and to facilitate better sleep when taken at night. "Some muscle relaxants can also be beneficial in certain headache conditions or even neurological pain," says Gharibo.
And their benefits have been well studied. Rich says there have been "well-designed systematic reviews of these prescriptions" dating back more than two decades, and that such research has "provided high-quality evidence illustrating these medications are more effective than placebo for short-term relief of muscle spasms, primarily low back pain."
Still, Bracamonte says the medications don't work for everyone, and some people report only limited relief. "I often prescribe my patients muscle relaxers to use along with other treatment options, including surface remedies, to maximize their combined effectiveness," he says.
When should I use a muscle relaxer?
Muscle relaxers may be a good option for anyone struggling with muscle-related pain or muscle spasms, but Rich says it's important to note "that all medications have side effects, and no medication is risk-free." That's why muscle relaxers must be prescribed by physicians, where "informed and shared decision-making with the patient" can occur and "anticipated benefits, potential adverse effects, and expected response," can be ascertained, says Rich.
Is ibuprofen a muscle relaxer?
Currently, there are no over-the-counter muscle relaxers available in the U,S., but some medications, such as NSAIDs (nonsteroidal anti-inflammatory drugs) and acetaminophen can help treat pain, inflammation, and soreness, and those don't require a prescription.
What is the downside of muscle relaxers?
The most common side effects of using muscle relaxers is that they are known to cause extreme drowsiness in some people. "For this reason, physicians will often caution patients to not drive or operate machinery while on therapeutic dosing," says Rich.
In some cases, muscle relaxers can also be habit forming, warns Bracamonte. And they may also cause "poor focus, dry mouth, and liver enzyme elevation and low blood pressure," says Gharibo.
Adam Tenforde, MD, director of running medicine for Mass General Brigham in Boston, Massachusetts, says that some users have also reported difficulty concentrating and that there is a risk of muscle relaxers negatively interacting with other medications. "Muscle relaxers should be used with caution − especially for those already taking medications that act on the central nervous system," advises Tenforde, "and you should avoid drinking alcohol while taking them as this can cause excessive sedation."
This article originally appeared on USA TODAY: What do muscle relaxers do? What to know before taking them
