Is the use of muscle relaxants acceptable in treating muscle spasm and pain in the lower extremity of a patient with multiple sclerosis?

From the Guidelines

The use of muscle relaxants, such as baclofen and tizanidine, can be acceptable for treating muscle spasm and pain in the lower extremity of multiple sclerosis patients, but they should be used cautiously and as part of a comprehensive treatment approach. When considering treatment options, it's essential to weigh the benefits and risks of each medication.

• Baclofen, starting at 5mg three times daily, gradually increasing to 20-25mg three times daily as needed, acts on GABA-B receptors in the spinal cord to reduce spasticity.
• Tizanidine, starting at 2mg daily, gradually increasing to 2-4mg three times daily, is an alpha-2 adrenergic agonist that reduces excitatory neurotransmitter release.
• Diazepam may be used short-term for severe spasms (2-10mg daily divided into 2-4 doses), but its use should be limited due to the risk of dependence and sedation. These medications can have side effects, including sedation, weakness, and dizziness, which may worsen existing MS symptoms 1. Treatment should be initiated at low doses and titrated slowly while monitoring for adverse effects. Physical therapy, stretching exercises, and proper positioning should accompany medication management. For patients with severe, localized spasticity unresponsive to oral medications, botulinum toxin injections may be considered, as recommended by recent guidelines 1. Regular reassessment of medication efficacy and side effects is essential to optimize treatment. It's crucial to prioritize the patient's quality of life, morbidity, and mortality when making treatment decisions, and to consider the most recent and highest-quality evidence available.

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. Tizanidine’s capacity to reduce increased muscle tone associated with spasticity was demonstrated in two adequate and well controlled studies in patients with multiple sclerosis or spinal cord injury.

The use of muscle relaxants, such as baclofen and tizanidine, is acceptable in treating muscle spasm and pain in the lower extremity of a patient with multiple sclerosis. These medications have been shown to be effective in reducing muscle tone and relieving symptoms of spasticity associated with multiple sclerosis 2 3. Key benefits of using these muscle relaxants include:

• Relief of flexor spasms and concomitant pain
• Reduction of muscle tone and frequency of spasms
• Improvement in muscle rigidity and clonus.

From the Research

Treatment of Muscle Spasm and Pain in Multiple Sclerosis

The use of muscle relaxants in treating muscle spasm and pain in the lower extremity of a patient with multiple sclerosis is a common practice.

• Muscle relaxants such as tizanidine and baclofen are often used to treat spasticity and painful muscle spasms in MS patients 4, 5, 6.
• These medications have been shown to be effective in reducing spasticity and improving muscle strength, bladder function, and activities of daily living 5, 6.
• Other treatment options for pain in MS include tricyclic antidepressants, antiepileptic medications, and cannabinoids 7.
• Gabapentin has also been shown to be effective in treating spasticity and painful muscle spasms in MS patients 8.

Efficacy of Muscle Relaxants

• Tizanidine has been compared to baclofen in several studies and has been shown to be equally effective in reducing spasticity and improving muscle strength 5, 6.
• Baclofen has been shown to be effective in reducing spasticity, but may have more side effects such as muscle weakness 5.
• Gabapentin has been shown to be effective in treating spasticity and painful muscle spasms, and may be a useful alternative to other muscle relaxants 8.

Side Effects and Considerations

• Muscle relaxants such as tizanidine and baclofen may have side effects such as drowsiness, dry mouth, and muscle weakness 5, 6.
• Gabapentin may have side effects such as dizziness, fatigue, and nausea 8.
• The use of muscle relaxants in MS patients should be carefully monitored and adjusted as needed to minimize side effects and optimize efficacy 4, 7.