Neither Baclofen nor Robaxin (Methocarbamol) Are Appropriate for Arthritis Pain
Neither baclofen nor methocarbamol should be used for arthritis pain, as they are muscle relaxants indicated for spasticity and musculoskeletal spasms respectively—not for joint pain from arthritis. Baclofen is FDA-approved only for spasticity from multiple sclerosis and spinal cord conditions, and is explicitly "not indicated in the treatment of skeletal muscle spasm resulting from rheumatic disorders" 1. Methocarbamol similarly lacks evidence for efficacy in arthritis-related joint pain 2.
What You Should Use Instead
First-Line Treatment: Acetaminophen or NSAIDs
Start with acetaminophen (paracetamol) up to 4000 mg/day as the initial pharmacologic treatment for osteoarthritic pain, as it is the most cost-effective option with the best safety profile 3.
If acetaminophen provides inadequate relief, escalate to NSAIDs (ibuprofen, naproxen, or diclofenac) at maximum tolerated doses, as they are more effective than acetaminophen for moderate-to-severe arthritis pain 3, 4.
NSAIDs demonstrate superior pain reduction compared to acetaminophen, with the average NSAID-treated patient experiencing less pain than 64% of patients on simple analgesics 3.
Critical Safety Considerations for NSAIDs
For patients with gastrointestinal risk factors, use either a COX-2 selective inhibitor or combine a nonselective NSAID with a proton-pump inhibitor 4.
Avoid NSAIDs entirely in patients with cardiovascular disease, recent bypass surgery, unstable angina, or recent myocardial infarction 4.
Monitor renal function when prescribing NSAIDs, particularly in elderly patients 4.
Acetaminophen can cause hepatotoxicity at doses >3-4 grams/day and at lower doses in patients with chronic alcohol use or liver disease 3.
Second-Line Options
Duloxetine is conditionally recommended as the next pharmacological treatment for patients who do not respond to NSAIDs 4.
Tramadol may be considered for knee, hip, and hand osteoarthritis, but should not be used long-term due to modest benefits and risk of dependence 4.
Intra-articular glucocorticoid injections can provide short-term improvement in pain and function for osteoarthritis or rheumatoid arthritis 3.
Non-Pharmacologic Interventions Are Essential
Exercise therapy is strongly recommended as core treatment, with high-quality evidence showing sustained pain reduction and functional improvement for 2-6 months in hip and knee osteoarthritis 3, 4.
Weight loss is strongly recommended for overweight/obese patients with arthritis 4.
Physical therapy should be considered when home exercises alone are insufficient 3.
Common Pitfalls to Avoid
Do not use muscle relaxants like baclofen or methocarbamol for arthritis pain—they target muscle spasticity and spasms, not inflammatory or degenerative joint pain 1, 2.
Do not use long-term opioids for osteoarthritis, as they are conditionally recommended against due to limited benefit and high risk of adverse effects 4.
Do not prescribe glucosamine or chondroitin, as they lack sufficient evidence of efficacy 4.
Avoid long-term systemic glucocorticoids for osteoarthritis management 4.