Muscle Relaxers Are Not the Answer to Sciatica Dr Lichter and Associates
Inadequate blinding has been believed to be responsible for bias in previous trials suggesting benefit from ascorbic acid55 and zinc56 for the common cold. Our results may be particularly prone to this bias, since most outcomes are based on physician rather than patient reports of symptom improvement. One of our studies18 that used patient ratings had results consistent with those based on physician ratings. Another study30 explored the potential biasing effect of higher rates of adverse effects by stratifying patient results by the presence or absence of adverse effects.
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In this article we’ll discuss piriformis syndrome, a condition in which the piriformis muscle presses on the sciatic nerve, resulting in sciatic pain called sciatica. We’ll explain how piriformis syndrome is diagnosed, treatment options for the condition, and their risks and benefits. Several over-the-counter (OTC) medications may provide sciatica pain relief. If you have other medical conditions, such as stomach, heart, or kidney problems, it’s a good idea to consult with your doctor before taking any medication to reduce the risk of side effects. Physical therapy for piriformis syndrome carries few risks outside of some peripheral pain and discomfort while performing exercises.
Patients treated with cyclobenzaprine were significantly more likely to experience adverse effects (Table 3). Fifty-three percent of the patients receiving cyclobenzaprine experienced at least one adverse effect, compared with 28% receiving placebo. The most common adverse effects included drowsiness, dry mouth, and dizziness. Despite these guidelines, what is flexeril? cyclobenzaprine hydrochloride is still commonly used in the management of acute back pain. It is used in conjunction with rest, physical therapy, and other treatments to relax muscles and relieve pain and discomfort caused by strains, sprains, and other muscle injuries. It works by relaxing the muscles by acting on the brain and nervous system.
When trials from clinical trial registries (mean difference −10.2, 95% confidence interval −15.6 to −4.7) or trials without a placebo comparator (−11, −17 to −5.1) were excluded, the estimated effect for pain intensity (≤2 weeks) changed to within the minimum clinically important difference. When excluding trials at high risk of bias, however, the effect decreased to zero (0.2, −4.9 to 5.4). Two reviewers independently identified studies, extracted data, and assessed the risk of bias and certainty of the evidence using the Cochrane risk-of-bias tool and Grading of Recommendations, Assessment, Development and Evaluations, respectively.
When standing and sitting, make sure your back is straight, and your shoulders are back. A heat compress or pack can also relieve pain by increasing circulation and loosening up tight muscles. “Flexeril and Percocet are the only medicines that help me out of pain with a herniated L5 dics and a pinched nerve.” “Has helped tremendously. I am taking 10mg twice a day plus a narcotic. I feel Great as long as I get enough sleep. Virtually no pain due to severe osteoarthritis.”
Studies comparing the relative value of acetaminophen, nonsteroidal anti-inflammatory drugs, and cyclobenzaprine individually and in combination in the treatment of back pain are needed. For more severe pain, your provider may recommend electrotherapy such as TENS. This treatment uses electrical stimulation to reduce pain and stop muscle spasms. Also, for more severe pain, your provider may recommend physical therapy focusing on muscle and core strengthening to reduce pain and muscle spasms.
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Although the frequency and severity of adverse reactions observed in patients treated with FLEXERIL were comparable to those observed in patients treated with diazepam, dry mouth was observed more frequently in patients treated with FLEXERIL and dizziness more frequently in those treated with diazepam. The incidence of drowsiness, the most frequent adverse reaction, was similar with both drugs. The plasma concentration of cyclobenzaprine is increased in the elderly (see CLINICAL PHARMACOLOGY, Pharmacokinetics, Elderly).
Data sources and searches
Cyclobenzaprine was given in 10-mg tablets, except in 2 studies,18,21 in which 5-mg tablets were used. The daily dose ranged from 10 to 60 mg, titrated based on the adverse effects, with a median dose of 30 mg/d. One study21 used a twice-daily dose of cyclobenzaprine, and the remainder of the studies18,22,24,25,30-37 used 3 times daily doses. The study duration averaged 12.3 days, ranging from 7 to 18 days (median, 14 days).
- Objective To perform a systematic review of cyclobenzaprine’s effectiveness in the treatment of back pain.
- Physical therapy is the standard first-line treatment for piriformis syndrome (6).
- As a last resort, if all other treatment options fail, your doctor may recommend an operation for treatment of piriformis syndrome.
Random effects meta-analytical models through restricted maximum likelihood estimation were used to estimate pooled effects and corresponding 95% confidence intervals. Outcomes included pain intensity (measured on a point scale), disability (0-100 point scale), acceptability (discontinuation of the drug for any reason during treatment), and safety (adverse events, serious adverse events, and number of participants who withdrew from the trial because of an adverse event). Outcomes included global improvement and 5 specific domains of back pain (local pain, muscle spasm, range of motion, tenderness to palpation, and activities of daily living). The search strategies were developed and piloted by the review team for bibliographic databases and clinical trial registries using medical subject headings or Emtree and text words for “low back pain”, “randomised controlled trials”, and “spasmolytic muscle relaxant medicines” (see supplementary files 2 and 3). We searched the reference lists from retrieved full text articles and previous systematic reviews. Searches were also done through PROSPERO for any ongoing or recently completed systematic reviews.
Also, remember to take your wallet and other objects out of your back pockets when you sit down. “I have taken this medcation for years. When my sciatica acts up, I take two and Aleve and go to bed, within a few hours I start feeling better. It is not a pain killer–it is a muscle relaxer.” Ask your healthcare professional how you should dispose of any medicine you do not use.