What are the best treatments for severe back spasms?

Management of Severe Back Spasms

For severe back spasms, the most effective approach is a combination of non-pharmacological treatments including exercise therapy, heat application, and short-term muscle relaxants as an adjunct to physical therapy. 1, 2

First-Line Non-Pharmacological Treatments

• Apply heat therapy to the affected area, which provides moderate pain relief and reduced disability compared to placebo 1
• Begin a supervised exercise program that incorporates individual tailoring, stretching, and strengthening components 1
• Massage therapy shows moderate effectiveness for back pain with muscle spasm 1
• Spinal manipulation may provide small to moderate benefits for pain relief 3, 1

Pharmacological Management

• Skeletal muscle relaxants are moderately superior to placebo for short-term pain relief (2-4 days) in acute back spasms 3
• Cyclobenzaprine is FDA-approved as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions 2
• Muscle relaxants should be used only for short periods (up to 2-3 weeks) as there is inadequate evidence for longer use 2
• Be aware that muscle relaxants are associated with central nervous system side effects including drowsiness, fatigue, and dizziness 3, 4

Treatment Algorithm Based on Duration of Symptoms

For Acute Back Spasms (<4 weeks)

1. Begin with heat therapy and gentle movement 1
2. Consider a short course (3-7 days) of a muscle relaxant like cyclobenzaprine 2, 5
3. Start supervised exercise therapy after the initial acute phase 3
4. Combine with analgesic medication if needed for pain control 6

For Chronic Back Spasms (>12 weeks)

1. Focus on consistent exercise therapy with professional supervision 1
2. Incorporate motor control exercises that target specific muscle groups 1
3. Consider multidisciplinary rehabilitation for persistent symptoms 1
4. Limit use of muscle relaxants to short-term flare-ups only 2

Important Considerations and Pitfalls

• The effect of muscle relaxants is greatest in the first 4 days of treatment, suggesting shorter courses may be better 5
• Cyclobenzaprine has been shown to be nearly 5 times more likely to produce symptom improvement by day 14 compared to placebo, though the magnitude of improvement is modest 5
• Avoid prolonged use of muscle relaxants as evidence for effectiveness beyond 2-3 weeks is lacking 2
• Different exercise regimens appear similarly effective, suggesting patient preference and adherence may be more important than specific exercise type 1
• Lumbar supports have not shown clear benefits for back pain with muscle spasm 1
• Transcutaneous electrical nerve stimulation (TENS) shows no significant difference compared to sham treatment 1

Evidence of Combined Therapy

• A combination of an effective analgesic and a muscle relaxant for less than a week appears to be an excellent relief measure for acute back problems 6
• The pain-spasm-pain cycle theory suggests that breaking this cycle through combined interventions (reducing both pain and muscle spasm) may be more effective than single-modality approaches 7