What is the recommended treatment for back spasms?

From the Guidelines

The recommended treatment for back spasms typically involves a combination of rest, over-the-counter pain medications, and gentle stretching, with non-steroidal anti-inflammatory drugs (NSAIDs) or skeletal muscle relaxants being considered for pharmacologic treatment, as suggested by the American College of Physicians guideline 1. For immediate relief, applying ice for the first 48-72 hours (20 minutes on, 20 minutes off) can reduce inflammation, followed by heat therapy to relax tight muscles.

• Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg every 6-8 hours with food) or naproxen (220-500mg twice daily) can help manage pain and inflammation, as they have moderate-quality evidence supporting their use 1.
• Muscle relaxants such as cyclobenzaprine (5-10mg three times daily) or methocarbamol (750mg every 8 hours) may be prescribed for severe spasms, with skeletal muscle relaxants being found to be moderately superior to placebo for short-term pain relief in a Cochrane review 1. Gentle stretching exercises, particularly those targeting the lower back and hamstrings, can help prevent recurrence.
• Maintaining proper posture, using ergonomic furniture, staying physically active with low-impact exercises like swimming or walking, and strengthening core muscles are important for long-term management. Back spasms occur when muscles contract involuntarily due to injury, overuse, or poor posture, causing inflammation and pain. If symptoms persist beyond two weeks, are accompanied by fever, numbness, or bladder/bowel issues, or if pain radiates down the legs, medical attention should be sought immediately. The American College of Physicians guideline recommends selecting nonpharmacologic treatment with superficial heat, massage, acupuncture, or spinal manipulation for patients with acute or subacute low back pain, and considering pharmacologic treatment with NSAIDs or skeletal muscle relaxants if desired 1.

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 The recommended treatment for back spasms is cyclobenzaprine as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions 2.

• Duration of treatment: up to two or three weeks
• Key consideration: cyclobenzaprine should be used only for short periods because adequate evidence of effectiveness for more prolonged use is not available.

From the Research

Treatment Options for Back Spasms

• The recommended treatment for back spasms includes pharmacologic management, with acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line treatment options for most patients with acute mild to moderate pain 3.
• Topical NSAIDs are recommended for non-low back, musculoskeletal injuries, while acetaminophen is well tolerated, but lower doses should be used in patients with advanced hepatic disease, malnutrition, or severe alcohol use disorder 3.
• Muscle relaxants may be useful for acute low back pain, and adjunctive medications may be added as appropriate for specific conditions if the recommended dose and schedule of first-line agents are inadequate 3.

Combination Therapy

• The combination of ibuprofen and acetaminophen has been studied as an alternative to opioids in the management of common pain types, including back spasms 4.
• A fixed-dose combination of ibuprofen and acetaminophen has been shown to provide pain relief similar to or better than opioid and nonopioid comparators, with fewer adverse events 4.
• However, another study found that adding acetaminophen to ibuprofen does not improve outcomes within 1 week for patients with acute, nontraumatic, nonradicular low back pain 5.

Safety Considerations

• The concomitant use of ibuprofen and paracetamol does not appear to modify the risk of major clinical safety outcomes, such as upper gastrointestinal events, myocardial infarction, and renal failure, compared with paracetamol or ibuprofen alone 6.
• The risks of these safety outcomes are generally proportional over time, from current to past exposure, following a prescription for concomitant paracetamol and ibuprofen compared with ibuprofen alone or paracetamol alone 6.