From the Guidelines
The best treatment for acute back spasm typically involves a combination of rest, pain management, and gentle movement, with skeletal muscle relaxants being moderately superior to placebo for short-term pain relief, as found in a higher-quality Cochrane review 1. When treating acute back spasm, it is essential to prioritize a multimodal approach that addresses pain, inflammation, and muscle relaxation.
- Initially, take over-the-counter pain medications like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily) to reduce inflammation and pain, as recommended by the American College of Physicians and the American Pain Society 1.
- Apply ice for the first 48-72 hours (20 minutes on, 20 minutes off), then switch to heat therapy using a heating pad or warm bath for 15-20 minutes several times daily.
- Limit bed rest to 1-2 days maximum, as prolonged inactivity can worsen stiffness.
- Begin gentle stretching exercises like knee-to-chest pulls and pelvic tilts once the acute pain subsides.
- Muscle relaxants such as cyclobenzaprine (5-10mg three times daily) or methocarbamol (750mg every 8 hours) may be prescribed for severe spasms, typically for 7-10 days, as they have been found to be moderately superior to placebo for short-term pain relief 1. It is crucial to note that 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. If pain persists beyond 1-2 weeks or is accompanied by leg weakness, numbness, or bladder/bowel issues, seek medical attention as these may indicate a more serious condition requiring different treatment.
From the FDA Drug Label
Cyclobenzaprine hydrochloride tablets, USP are indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions. The best treatment for acute back spasm is cyclobenzaprine as an adjunct to rest and physical therapy 2.
- Key points:
- Relief of muscle spasm and its associated signs and symptoms
- Use for short periods (up to 2 or 3 weeks)
- Not effective for spasticity associated with cerebral or spinal cord disease, or in children with cerebral palsy.
From the Research
Treatment Options for Acute Back Spasm
The best treatment for acute back spasm involves a combination of medications and physical therapy. Some studies suggest that combining a nonsteroidal anti-inflammatory drug (NSAID) with a muscle relaxant can provide effective relief from acute back pain and muscle spasm 3, 4, 5.
Medication Combinations
- Cyclobenzaprine and naproxen: This combination has been shown to be effective in reducing muscle spasm and pain in patients with acute low back pain 3.
- Ibuprofen and cyclobenzaprine: A study found that combination therapy with ibuprofen and cyclobenzaprine was not superior to cyclobenzaprine alone in adult patients with acute neck and back pain with muscle spasm 6.
- Chlorzoxazone and ibuprofen: A fixed-dose combination of chlorzoxazone and ibuprofen demonstrated superior efficacy compared to ibuprofen monotherapy in acute low back pain 4.
- Eperisone hydrochloride and ibuprofen: The combination of eperisone hydrochloride and ibuprofen effectively reduced pain and improved functional outcomes compared to ibuprofen alone in patients with acute non-specific back pain with muscle spasm 7.
Key Findings
- Combination therapy with an NSAID and a muscle relaxant can provide effective relief from acute back pain and muscle spasm 3, 4, 5.
- The choice of medication combination may depend on individual patient needs and medical history.
- Physical therapy and rest are also important components of treatment for acute back spasm 3.