Many doctors are prescribing muscle relaxants for low back pain to avoid writing prescriptions for opioids. Unfortunately, muscle relaxants come with their own addictive potential and severe side effects. Recent studies have shown that they may not be as effective for low back pain as initially thought. Here’s an in-depth look at what the science says about muscle relaxants and alternative treatments for back pain.
Muscle Relaxants Vs. Placebo
In a well-designed scientific study, one group of patients will be given the actual treatment, and another will be given something that they think is the actual treatment but isn’t. This is called a placebo. Studies are designed this way to counter what doctors call the “placebo effect.” The placebo effect is a phenomenon where a person who thinks they have been given a treatment that will help them feel better will experience reduced symptoms (usually for a short time). Scientists compare the results of patients who are given a placebo versus those given an actual treatment to see if the treatment actually works or if patients just think it works and are experiencing a mind over matter reaction.
A well-designed study will also include a large group of people to represent diverse reactions and may have a double-blind component. This means that the people evaluating the results don’t know which group of patients were given the placebo and which were given the treatment. This helps to remove bias from the results of the study. As with all scientific experiments, a valid clinical study should be able to be replicated by a different team of researchers and achieve the same results.
Some of the first studies done on muscle relaxants in the 1980s showed a modest improvement over placebo, but these studies were not well designed. In 1988 a much better designed, randomized clinical trial found that muscle relaxants were not superior to placebo. In 2011 a research team employed by a pharmaceutical company found a 24% improvement in pain over placebo. The results of this study have never been replicated.
Recent, good-quality randomized trials have shown that the top seven muscle relaxants, including valium (diazepam), are no more effective than placebo for acute or chronic back pain. The Department of Health and Human Services recently acknowledged this fact. Government health organizations, including Medicaid, now recommend that these drugs not be used as the first line of treatment.
It is expected that now that this knowledge has become more widespread, insurance companies may decide not to approve payments for muscle relaxants. Fortunately, recent studies have also found that there is an effective, safe alternative.
Why Were Muscle Relaxants Approved If They Aren’t Effective?
The FDA approved skeletal muscle relaxants like carisoprodol, chlorzoxazone, cyclobenzaprine, methocarbamol, and antispasmodics like diazepam under very specific conditions for use. When used to treat muscle pain and acute muscle spasms, they are only supposed to be used for 2-3 weeks. Yet, surveys have shown that despite this recommendation, many doctors keep patients on these drugs for years.
The FDA recommends the 2-3 week period of treatment for two reasons. Firstly, when these drugs are effective, they are only effective in the short term. Secondly, the risk of addiction and side effects is considered too great for long-term use. According to the FDA, the other condition for use is that these drugs are supposed to be prescribed alongside other treatments such as adjustment, exercises, hot and cold therapy, etc. Unfortunately, many doctors don’t recommend these other treatments to patients. Instead, they prescribe muscle relaxants as the only therapy.
According to the FDA, muscle relaxants are a short-term band-aid treatment meant to get patients through the worst pain until they can heal.
Chiropractic Adjustment Vs. Muscle Relaxants
In a recent study conducted by four chiropractors, two Ph.D.’s and one M.D., chiropractic adjustment was compared to muscle relaxants and placebo in a group of 190 patients who had experienced low back pain for 2-6 weeks. The patients were divided into three groups: chiropractic manipulations with placebo medicine, muscle relaxants with sham manipulations, or placebo medicine with sham manipulations.
This study replicated the results of others, showing that those in the muscle relaxant group and placebo medicine with sham manipulations group did not experience a significant difference in their pain or functioning. The group that received chiropractic manipulations experienced a 49% improvement over the other two groups.
Chiropractic manipulation works by addressing the underlying causes of the pain. Many back injuries are caused by preventable situations like bad posture or not enough core strength. In addition to treating injuries, chiropractors also educate their patients on how to take care of their backs. This combination of effective treatment and education leads to better long-term outcomes than medication.
A Safer Treatment
In addition to being more effective than muscle relaxants, chiropractic adjustment is also safer. Chiropractic adjustment has been practiced in the U.S. for nearly one hundred years. In that time, there have been no serious side effects reported by patients who were treated by licensed professionals.
Muscle relaxants, on the other hand, come with a laundry list of risks, including addiction. Overdose can be fatal, and serious side effects like heart problems, low blood pressure, liver problems, and dizziness can occur even when they are taken as directed. These side effects can be especially problematic for older adults and people on other medications. Sadly, it is not uncommon for side effects like dizziness or fainting to lead to falls in older adults that result in severe bone breaks and a deterioration in overall health. When muscle relaxants are used alongside opiates, they increase the risk for fatal overdose.
Given these risks and the lack of evidence for effectiveness, the medical community is now questioning the use of muscle relaxants for back pain, and suggesting alternative treatments.
At Burkhart Chiropractic, we specialize in treating patients with acute and chronic back pain. We have seen our patients’ lives changed for the better by chiropractic care, and we believe we can do the same for you. Give us a call today to schedule a consultation and get the effective, safe care that you deserve.