Muscle Relaxers/Relaxants

Muscle relaxants help relieve pain and other symptoms caused by muscle spasms and muscle spasticity, There are many different types available, including over-the-counter (OTC), prescription, off-label, and natural muscle relaxants. Some of them carry a high risk of abuse and addiction.
Evidence Based
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What is a Muscle Relaxer (Relaxant)?

Muscle relaxers, or muscle relaxants, are medications that treat muscle spasms or muscle spasticity by decreasing the body’s muscle tone.

  • Muscle spasms, commonly referred to as cramps, are quick and unexpected contractions of a muscle or group of muscles.
  • Muscle spasticity is a continuous spasm that causes muscle stiffness or tightness.
  • Muscle tone refers to the muscle’s resistance to stretch in a relaxed state.

Skeletal muscle spasms are the most common type of cramp and come from overuse, muscle fatigue, dehydration, or electrolyte abnormalities. Spasms are usually abrupt, painful, and short-lived.

Causes of Muscle Spasms

Conditions that lead to muscle spasms include:

  • Back pain
  • Neck pain
  • Fibromyalgia
  • Obesity
  • Diabetes
  • Anemia (low red blood cell count)
  • Kidney disease
  • Hormone issues (thyroid disorders)

Muscle spasticity may interfere with everyday activities such as walking, talking, or bending. It often originates from damage to an area of the brain or spinal cord that regulates voluntary movement.

Muscle spasticity has adverse effects on the joints and muscles of extremities, especially in growing children. Symptoms range from mild tightness to severe pain.

Causes of Muscle Spasticity

Conditions that lead to muscle spasticity include:

  • Cerebral Palsy (CP)
  • Multiple sclerosis (MS)
  • Spinal cord injuries
  • Traumatic brain injuries
  • Brain damage
  • Stroke
  • Encephalitis
  • Meningitis
  • Adrenoleukodystrophy (ALD)
  • Amyotrophic lateral sclerosis (Lou Gehrig's disease or ALS)
  • Phenylketonuria

Millions of Americans currently use muscle relaxants. Middle-aged adults are the most frequent users.

NHANES III
Graphic human body showing symptoms.

What Do Muscle Relaxers Do?

Muscle relaxants can help relieve pain and other symptoms caused by muscle spasms and spasticity. They are unique because scientists and doctors still don’t understand how many of them work.

There are two categories of muscle relaxants:

  • Antispasmodics — also known as centrally acting skeletal muscle relaxants (SMRs) are used, along with rest and physical therapy, to relieve muscle spasms.
  • Antispastics — are used to treat muscle spasticity, and shouldn’t be used to treat spasms.

Doctors believe that spasms are caused by your nerves sending an excessive amount of signals to your brain. Muscle relaxants reduce the number of signals sent between your nerves and your brains. This is commonly referred to as a “sedative effect.”

Graphic of 3 different types of medication bottles and pills.

Uses of Muscle Relaxants

Muscle relaxants treat acute pain; however, in some cases, they can treat chronic pain. Acute pain lasts for a short amount of time, whereas chronic pain lasts for longer than six months.

They are also used to treat certain disorders and ailments that produce muscle spasms or spasticity.

Muscle Relaxers for Neck & Back Pain

Back pain is the number one ailment that calls for a muscle relaxant prescription. Neck pain, upper back pain, and lower back pain can be caused by, or be the cause of, tense or spasming muscles.

Doctors always prescribe muscle relaxants in conjunction with rest and physical therapy. Doctors may use them early on to reduce pain associated with muscle spasms. They may also get prescribed when back or neck pain causes insomnia — due to their sedative effects.

Muscle relaxers can also help treat restless leg syndrome and sore muscles.

Treating Other Disorders

Muscle relaxants may be used to treat a variety of other conditions, including:

  • Cerebral palsy
  • Multiple sclerosis
  • Motor neurone diseases (MND)
  • Head or spinal cord injuries
  • Irritable bowel syndrome (IBS)
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Types of Muscle Relaxers

Muscle relaxants encompass a large group of different types and classes of substances. They include natural, over-the-counter, and prescription medications.

The following is an overview of the most common types of muscle relaxants:

Over-the-Counter (OTC) Muscle Relaxants

OTC medications are typically the first type of muscle relaxants that doctors prescribe, and include:

Generic nameBrand nameFormUsed to treat
AcetaminophenTylenol, ParacetamolTablet/Capsule, Liquid, Injection,
Suppository
Minor aches and pain,
Fever
IbuprofenAdvil, MotrinTablet/Capsule, Liquid, InjectionPain, Inflammation, Fever
NaproxenAleveTablet, Liquid, SuppositoryAcute pain,
Inflammation

Prescription Muscle Relaxants

Along with rest and physical therapy, doctors will use prescription muscle relaxants when pain is more severe, or if OTC medications do not have the desired effect.

Antispasmodic prescription muscle relaxants, or centrally acting SMRs include:

Generic nameBrand nameFormUsed to treat
CarisoprodolSomaTabletSkeletal muscle
pain or injury
ChlorzoxazoneParafon Forte,
Lorzone
TabletMuscle spasms,
muscle pain,
musculoskeletal
conditions
CyclobenzaprineFexmid, Flexeril,
Amrix
Tablet,
Extended-release
capsule
Skeletal muscle
pain or injury
MetaxaloneSkelaxin,
Metaxall
TabletSkeletal muscle
pain or injury
MethocarbamolRobaxinTabletSkeletal muscle
pain or injury
OrphenadrineNorflexExtended-release
tablet
Skeletal muscle pain or
injury, Parkinson’s Disease
TizanidineZanaflexTablet, CapsuleMultiple Sclerosis, Spinal
cord injury

Antispastic Prescription Muscle Relaxers

Some types of antispastic prescription muscle relaxers include:

Generic nameBrand nameFormUsed to treat
BaclofenLioresal, GablofenTablet, InjectionMultiple Sclerosis
DantroleneDantriumTabletMultiple Sclerosis, Cerebral Palsy,
Strokes, Spinal cord injury
DiazepamValiumOral suspension, Tablet,
Injection
Inflammation, Muscle trauma,
Muscle spasticity

Off-Label Muscle Relaxants

Off-label drug use refers to when a doctor prescribes medication in a way that is not approved by the FDA. It may be that the drug is not FDA approved to treat a certain ailment, age group, or that the dosage or route of administration hasn’t been approved.

Some off-label medications are not technically muscle relaxants but may be prescribed by doctors to relieve symptoms of spasticity, including:

Generic nameBrand nameFormUsed to treat
ClonazepamKlonopinTabletSeizures, Anxiety,
Muscle spasms
LorazepamAtivanTablet, LiquidAnxiety, IBS,
Substance withdrawal
AlprazolamXanaxTablet, LiquidAnxiety, Panic attacks,
Muscle spasms
ClonidineKapvay, Catapres,
Jenloga
TabletHigh blood pressure, ADHD,
Muscle Spasms, Spasticity
GabapentinNeurontin, Gralise, HorizantTablet, LiquidSeizures, Nerve pain,
Restless leg syndrome

All Natural Muscle Relaxers

The FDA does not approve natural and holistic medicines, but many people believe that they are effective in pain relief. There is little to no scientific evidence to support these claims, but they may be useful for some people:

Generic nameBrand nameFormUsed to treat
Cannabidiol (CBD)-Tinctures and oil,
Topical, Capsule
Pain, Dystonia,
Insomnia
Cherries and blueberries-Fruit, JuiceMuscle pain, Inflammation
Cayenne pepper-Food, Capsule,
Topical
Fibromyalgia
Rheumatoid arthritis
Chamomile-Tea, OilMuscle spasms,
Sore muscles
Graphic human body showing symptoms.

Common Side Effects of Muscle Relaxers

Muscle relaxants, along with all prescription drugs, come with a number of possible side effects. They will vary depending on the type of drug, but the most common muscle relaxant side effects include:

  • Tiredness and drowsiness
  • Weakness
  • Dizziness
  • Nausea
  • Agitation
  • Light-headedness
  • Headaches
  • Forgetfulness
  • Muscle weakness (side effect of Diazepam)
  • Confusion
  • Shakiness
  • Sweating
  • Anxiety
  • Blurred Vision
  • Appetite Changes
  • Decreased blood pressure
  • Constipation
  • Dry mouth

Do not use muscle relaxants in conjunction with alcohol, central nervous system (CNS) depressants (opioids, benzodiazepines, barbiturates), or sleeping medications, as serious side effects may occur including death.

Discontinuing the use of some muscle relaxers after long-term use can result in withdrawal symptoms, such as hallucinations and seizures. Do not stop taking the medication without talking to your doctor first.

Pill bottle and skull

Muscle Relaxant Abuse and Addiction

Muscle relaxants are intended for short term treatments, typically two to three weeks. If they are used for longer, a patient will be at risk of misuse and abuse. Soma and Flexeril, the most commonly prescribed muscle relaxants, can lead to tolerance and dependence with prolonged use.

Muscle relaxants often get abused for their euphoric and dissociative effects. One in 20 people in the U.S. age 12 and up have reported using muscle relaxants recreationally. This can lead to addiction or overdose.

Muscle relaxant overdose symptoms include:

  • Stupor
  • Hallucinations
  • Shock
  • Seizures
  • Hyperventilation
  • Cardiac arrest
  • Coma
  • Death

Nearly 15,000 people die each year of overdoses involving prescription painkillers.

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Muscle Relaxer Addiction Treatment

There are several treatment options for people suffering from muscle relaxant addiction. The most commonly used treatment methods include:

If you or someone you know is suffering from a muscle relaxant addiction, reach out to a health care professional to review your treatment options.


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Resources

Prescription Painkiller Overdoses in the US. Centers for Disease Control and Prevention, 1 Nov. 2011, www.cdc.gov/vitalsigns/painkilleroverdoses/index.html.

Dillon, Charles & Paulose-Ram, Ryne & Hirsch, Rosemarie & Gu, Qiuping. (2004). Skeletal muscle relaxant use in the United States - Data from the Third National Health and Nutrition Examination Survey (NHANES III). Spine. 29. 892-6. 10.1097/00007632-200404150-00014.

Witenko, Corey et al. “Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain.” P & T : a Peer-reviewed Journal for Formulary Management vol. 39,6 (2014): 427-35.

Patel, Himanshu D et al. “Efficacy and Safety of Combination of NSAIDs and Muscle Relaxants in the Management of Acute Low Back Pain.” Pain and Therapy vol. 8,1 (2019): 121-132. doi:10.1007/s40122-019-0112-6

Richards BL, Whittle SL, Buchbinder R. Muscle relaxants for pain management in rheumatoid arthritis. Cochrane Database of Systematic Reviews 2012, Issue 1. Art. No.: CD008922. DOI: 10.1002/14651858.CD008922.pub2.

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Updated on: August 7, 2020
Author
Michael Bayba
About
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Medically Reviewed: March 18, 2020
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Annamarie Coy,
BA, CADACII/ICADC, ICPR, MATS
About
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