Baclofen Is Not Recommended for Back Pain
Baclofen is not indicated for back pain and should not be used for this condition. The FDA explicitly states that baclofen is not indicated for skeletal muscle spasm resulting from rheumatic disorders, and there is only sparse evidence (2 trials) supporting its use for low back pain 1, 2. The American College of Physicians does not recommend baclofen as a preferred option for muscle relaxant therapy in low back pain 3.
Why Baclofen Should Be Avoided for Back Pain
- Baclofen is primarily a GABAB agonist approved specifically for spasticity from multiple sclerosis and spinal cord diseases, not for musculoskeletal back pain 2
- There is minimal data supporting baclofen use for pain outside of spasticity-related conditions 1
- The FDA label explicitly excludes treatment of skeletal muscle spasm from rheumatic disorders 2
Preferred Treatment Options Instead
First-Line Pharmacological Treatment
- NSAIDs are the recommended first-line treatment for acute low back pain, with good evidence for effectiveness and moderate pain relief 3
- For chronic low back pain, NSAIDs or tricyclic antidepressants are recommended as first-line options 3
If Muscle Relaxant Is Needed
- Tizanidine is the preferred muscle relaxant for back pain, with demonstrated efficacy and a better safety profile than baclofen 3, 4
- Tizanidine should be started at 2-4 mg up to three times daily and titrated as needed 4
- Combining tizanidine with acetaminophen or NSAIDs provides consistently greater short-term pain relief than monotherapy 4
- Treatment should be time-limited (typically 7-14 days for acute pain) due to limited evidence on long-term use 4
For Radicular Symptoms
- Gabapentin is recommended as first-line therapy for lumbar radiculopathy, with demonstrated small, short-term benefits specifically for radicular symptoms 3, 4
- Gabapentin can be combined with tizanidine for patients with radiculopathy 4
Important Clinical Considerations
- All skeletal muscle relaxants, including baclofen, are associated with CNS adverse effects, primarily sedation 4
- Baclofen can cause significant adverse effects including dizziness, gastrointestinal symptoms, and may worsen obstructive sleep apnea 1
- Systemic corticosteroids are not recommended for low back pain with or without sciatica 3, 4
- Monitor for sedation with any muscle relaxant, and reassess if no improvement occurs after a time-limited course 4