Is tizanidine (a muscle relaxant) effective for treating nerve pain?

Tizanidine for Nerve Pain

Tizanidine is NOT effective for nerve pain (radiculopathy/sciatica) and should not be used for this indication. 1

Evidence Against Use in Nerve Pain

The American Pain Society/American College of Physicians guideline evidence review specifically evaluated tizanidine for sciatica and found no difference between tizanidine and placebo in a higher-quality trial of patients with sciatic nerve pain. 1 This is the most direct evidence addressing nerve pain specifically.

Where Tizanidine DOES Work

Tizanidine has demonstrated efficacy only in the following contexts:

Acute Low Back Pain (Musculoskeletal, NOT Nerve Pain)

• Tizanidine was efficacious for acute low back pain in 8 trials, but this was for mechanical back pain with muscle spasm, not radicular symptoms. 1
• The American College of Physicians recognizes tizanidine as an option for short-term relief of acute low back pain (2 weeks or less), but again, this is for musculoskeletal pain. 2
• Treatment duration in all trials was 2 weeks or less. 1

Spasticity (Its FDA-Approved Indication)

• Tizanidine is FDA-approved specifically for treating spasticity from upper motor neuron syndromes (stroke, multiple sclerosis, spinal cord injury), not peripheral nerve pain. 1, 3
• It reduces muscle tone by 21-37% versus 4-9% for placebo in spasticity patients. 3

Better Options for Nerve Pain

For radiculopathy/nerve pain, the evidence supports:

• Gabapentin: Small improvements in pain scores in 2 higher-quality trials for low back pain with radiculopathy. 1
• Topiramate: Small improvements in pain scores compared to placebo for radiculopathy. 1
• Tricyclic antidepressants: Small to moderate effects for chronic low back pain (though not specifically studied for pure radiculopathy). 1

Critical Distinction

The key pitfall is confusing muscle spasm pain (where tizanidine works) with nerve pain/radiculopathy (where it does not). 1 Nerve pain from radiculopathy requires medications that modulate nerve signaling (gabapentinoids, certain antidepressants), not muscle relaxants. 1

Safety Considerations

• Tizanidine causes significant hypotension requiring monitoring. 2
• Common adverse effects include drowsiness (reported in studies), dry mouth, and CNS depression. 3
• Central nervous system adverse events occur at twice the rate of placebo (RR 2.04). 1