From the FDA Drug Label
Cyclobenzaprine hydrochloride tablets are indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions Improvement is manifested by relief of muscle spasm and its associated signs and symptoms, namely, pain, tenderness, limitation of motion, and restriction in activities of daily living The initial medical treatment for patients with spinal canal stenosis experiencing muscle cramps around the spine may include cyclobenzaprine as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions 1.
- Key points:
- Cyclobenzaprine is used for short periods (up to two or three weeks)
- It is used as an adjunct to rest and physical therapy
- It is not found effective in the treatment of spasticity associated with cerebral or spinal cord disease 1
From the Research
The initial medical treatment for patients with spinal canal stenosis experiencing muscle cramps around the spine should prioritize a combination of pain management and physical therapy, with a focus on nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy as the first line of treatment. This approach is supported by recent studies, including a 2022 review published in JAMA 2, which highlights the importance of activity modification, analgesia, and physical therapy as first-line therapy for lumbar spinal stenosis.
Key components of this treatment plan include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) to reduce inflammation and pain
- Physical therapy focusing on core strengthening and flexibility exercises, initiated concurrently and continued for 6-8 weeks
- Application of heat therapy to the affected area for 15-20 minutes several times daily to improve blood flow and reduce muscle tension
- Consideration of muscle relaxants like cyclobenzaprine (5-10mg three times daily) or baclofen (5-20mg three times daily) for 1-2 weeks to address muscle spasms specifically
It's essential to note that while epidural steroid injections may be considered for patients who do not respond to conservative management, the long-term benefits of these injections have not been established, as highlighted in a 2025 systematic review published in Neurology 3. Surgery may be an option for carefully selected patients with persistent symptoms, but it is associated with greater risks and costs, as discussed in the 2022 JAMA review 2.
A recent meta-analysis published in 2023 in Frontiers in Pharmacology 4 suggests that pregabalin may have a significant effect on pain scores at 3 months, but the evidence is not strong enough to support its use as a first-line treatment. Therefore, a conservative approach with NSAIDs and physical therapy remains the most appropriate initial treatment for patients with spinal canal stenosis experiencing muscle cramps around the spine, with other interventions considered only if symptoms persist or worsen.