Muscle Relaxants Are Not Recommended for Finger Sprains
Muscle relaxants such as cyclobenzaprine (Flexeril) or metaxalone (Skelaxin) should not be used for finger sprains, as they are only indicated for acute, painful musculoskeletal conditions involving muscle spasm, and finger sprains do not involve true muscle spasm requiring these medications. 1, 2
Why Muscle Relaxants Are Inappropriate for Finger Sprains
FDA-Approved Indications Do Not Include Finger Injuries
Cyclobenzaprine is FDA-approved only as "an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions" and should be used only for short periods (up to two or three weeks). 1
Metaxalone is similarly indicated only "as an adjunct to rest, physical therapy and other measures for the relief of discomforts associated with acute, painful musculoskeletal conditions." 2
Critically, the FDA label for metaxalone explicitly states that "metaxalone does not directly relax tense skeletal muscles in man," meaning its mechanism is likely related to sedative properties rather than actual muscle relaxation. 2
Finger sprains involve ligamentous injury, not the type of muscle spasm these medications target (which typically refers to large muscle groups in conditions like acute low back pain). 1, 2
Evidence Shows Muscle Relaxants Are Not Effective for Musculoskeletal Pain
The American Geriatrics Society emphasizes that muscle relaxants should not be prescribed in the mistaken belief that they relieve muscle spasm, as their effects are nonspecific and not related to actual muscle relaxation. 3
Guidelines specifically state that muscle relaxants are not effective for musculoskeletal pain, and their use may lead to unnecessary medication side effects, including sedation and fall risk. 3
For older persons specifically, these drugs are associated with greater risk for falls. 3
Limited Evidence Base and Significant Side Effects
Evidence supporting muscle relaxants even for their approved indications (acute low back pain) shows only moderate effects, and most trials have involved acute rather than chronic pain. 4
A systematic review found that muscle relaxants like cyclobenzaprine, carisoprodol, and metaxalone have equal efficacy for their approved indications, but their side effects vary considerably, with all causing central nervous system effects including drowsiness, sedation, fatigue, and dizziness. 5, 6, 7
In rheumatoid arthritis patients, benzodiazepine muscle relaxants (diazepam, triazolam) and non-benzodiazepines (zopiclone) showed no benefit in improving pain over 24 hours to 2 weeks, but were associated with significant adverse events (number needed to harm = 3), predominantly drowsiness and dizziness. 8
There is concern that some of these medications can lead to abuse and addiction, particularly carisoprodol. 4, 5, 6
Common Pitfalls to Avoid
Do not prescribe muscle relaxants simply because a patient reports "muscle pain" or "stiffness" around a finger sprain—this does not represent true muscle spasm requiring these medications. 3, 1, 2
Avoid the misconception that these drugs directly relax muscles—their mechanism is primarily sedative, not muscle-specific. 2
Remember that finger sprains are ligamentous injuries requiring rest, ice, compression, elevation, and possibly NSAIDs for pain/inflammation—not muscle relaxants. 9