From the Guidelines
For acute muscle spasms, muscle relaxants such as cyclobenzaprine (Flexeril) 5-10mg three times daily, methocarbamol (Robaxin) 750mg every 8 hours, or baclofen 5-10mg three times daily are typically recommended as first-line medications. These medications work by acting on the central nervous system to reduce muscle tone and relieve spasms. Treatment duration is usually short-term, typically 7-14 days, to avoid dependence and side effects like drowsiness and dizziness 1.
Key Considerations
- Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen 400-600mg every 6-8 hours can be added to reduce inflammation and pain.
- For immediate relief before medications take effect, applying heat or cold to the affected area, gentle stretching, and rest are helpful complementary measures.
- Staying hydrated and maintaining proper posture can prevent worsening of symptoms.
- If muscle spasms persist beyond two weeks or are accompanied by severe pain, weakness, or numbness, medical evaluation is necessary as this could indicate a more serious underlying condition.
Medication Safety
- Skeletal muscle relaxants are associated with a higher total number of adverse events and central nervous system adverse events compared with placebo, although most events are self-limited and serious complications are rare 1.
- Opioid analgesics may be considered for patients with severe, disabling pain that is not controlled with acetaminophen and NSAIDs, but their use should be carefully weighed due to substantial risks, including aberrant drug-related behaviors with long-term use 1.
Treatment Approach
- The treatment approach should prioritize the patient's safety and well-being, with a focus on minimizing the risk of adverse events and dependence on medications.
- A multidisciplinary approach, including physical therapy, lifestyle modifications, and alternative therapies, may be beneficial for patients with chronic or recurrent muscle spasms.
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 medication for acute muscle spasms is cyclobenzaprine (PO), to be used for short periods (up to two or three weeks) as an adjunct to rest and physical therapy 2.
- Key points:
- Indicated for relief of muscle spasm associated with acute, painful musculoskeletal conditions
- Should be used only for short periods
- Not found effective in the treatment of spasticity associated with cerebral or spinal cord disease
From the Research
Medication for Acute Muscle Spasms
The recommended medication for acute muscle spasms includes cyclobenzaprine, which is a muscle relaxant that has been shown to be effective in improving muscle spasm, reducing local pain and tenderness, and increasing range of motion in acute, painful musculoskeletal conditions 3.
Key Findings
- Cyclobenzaprine 5 mg TID was found to be as effective as 10 mg TID, with a lower incidence of sedation 3.
- Once-daily cyclobenzaprine extended release (CER) 15- and 30-mg capsules were effective in treating muscle spasm associated with painful musculoskeletal conditions after 4 days of treatment 4.
- Combination therapy with cyclobenzaprine 5 mg TID plus ibuprofen was not superior to cyclobenzaprine 5 mg TID alone in adult patients with acute neck and back pain with muscle spasm 5.
- Cyclobenzaprine has been shown to have a rapid onset of action and few serious adverse experiences 6.
Comparison with Other Medications
- Cyclobenzaprine, metaxalone, and carisoprodol have been found to have equal efficacy, but their side effects vary considerably 7.
- Metaxalone has the fewest reports of side effects, while carisoprodol raises concerns about physical and psychological dependence and toxicity 7.