From the Guidelines
Baclofen is not recommended for the treatment of back pain due to insufficient evidence of its efficacy. The American College of Physicians and the American Pain Society have stated that there is little evidence for the efficacy of baclofen in treating low back pain 1. Baclofen is primarily used for treating muscle spasticity associated with conditions like multiple sclerosis or spinal cord injuries, rather than common back pain.
For most back pain, especially acute cases, other treatments are preferred. Some options include:
- Over-the-counter pain relievers like acetaminophen or NSAIDs such as ibuprofen or naproxen
- Non-medication approaches like physical therapy, gentle exercise, proper posture, and heat or cold therapy
- Tricyclic antidepressants for pain relief in patients with chronic low back pain and no contraindications to this class of medications 1
- Gabapentin for patients with radiculopathy, as it is associated with small, short-term benefits 1
It's essential to consult with a healthcare provider to determine the best course of treatment for specific back pain conditions, considering the potential risks and benefits of each option. Baclofen, if considered, should be used under medical supervision due to its potential side effects, such as drowsiness, dizziness, weakness, and fatigue.
From the FDA Drug Label
Baclofen tablets are useful for the alleviation of signs and symptoms of spasticity resulting from multiple sclerosis, particularly for the relief of flexor spasms and concomitant pain, clonus, and muscular rigidity. The answer to using Baclofen for back pain is that it may be useful for the relief of concomitant pain associated with spasticity resulting from multiple sclerosis or spinal cord injuries [ 2 ].
- Key points:
- Baclofen is indicated for spasticity resulting from multiple sclerosis or spinal cord diseases.
- It may provide relief for concomitant pain associated with these conditions.
- There is no direct indication for back pain in general, only for pain associated with spasticity.
From the Research
Baclofen for Back Pain
- Baclofen is a skeletal muscle relaxant used to treat spasticity and musculoskeletal conditions, including back pain 3.
- There is fair evidence that baclofen is effective in treating spasticity, primarily in patients with multiple sclerosis, but its effectiveness in treating musculoskeletal conditions such as back pain is limited 3.
- A study found that cyclobenzaprine, carisoprodol, and tizanidine are effective in treating musculoskeletal conditions, including back pain, but there is limited data on the effectiveness of baclofen for this condition 3, 4.
- Baclofen has been shown to be effective in reducing spasticity and improving functional outcomes in patients with spinal cord injury, but its use for back pain is not well established 5, 6, 7.
Efficacy and Safety of Baclofen
- Baclofen has been found to be effective in reducing spasticity, but its use is often limited by adverse effects such as muscle weakness, nausea, and somnolence 3, 5.
- Intrathecal baclofen has been shown to be an effective alternative to oral baclofen, with reduced adverse effects and improved efficacy 5, 6, 7.
- The safety profile of baclofen is generally well established, but there is a risk of rare serious hepatotoxicity associated with its use 3.
Comparison with Other Muscle Relaxants
- Baclofen has been compared to other muscle relaxants, including tizanidine and cyclobenzaprine, and has been found to be roughly equivalent in terms of efficacy, but with a different adverse effect profile 3, 4.
- The choice of muscle relaxant for back pain will depend on the individual patient's needs and medical history, as well as the specific condition being treated 3, 4.