Benefit, Safety of Muscle Relaxants for Low Back Pain Uncertain

uncertainty exists about the clinical efficacy and safety of muscle relaxants for the treatment of low back pain, according to the results of a systematic review and meta-analysis published online in The BMJ.

Aidan G. Cashin, from the Centre for Pain IMPACT at Neuroscience Research Australia in Sydney, and colleagues conducted a literature review to assess the efficacy, acceptability, and safety of muscle relaxants for low back pain.

Based on a meta-analysis of data from 31 of 49 identified studies (6,505 participants), the researchers found that for acute low back pain, very low-certainty evidence showed that at two weeks or less, nonbenzodiazepine antispasmodics were associated with a reduction in pain intensity versus control (mean difference −7.7, 95 percent confidence interval [CI], −12.1 to −3.3) but not a reduction in disability (−3.3; 95 percent CI, −7.3 to 0.7). Compared with control for acute low back pain, low and very low-certainty evidence showed that nonbenzodiazepine antispasmodics might increase the risk for an adverse event (relative risk, 1.6; 95 percent CI, 1.2 to 2.0) but might have little to no effect on acceptability (relative risk, 0.8; 95 percent CI, 0.6 to 1.1).

“Large, high-quality, placebo controlled trials are urgently needed to resolve uncertainties about the efficacy and safety of muscle relaxants for low back pain,” the authors write.

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