Importance Low back pain (LBP) is responsible for more than 2.5 million visits to US emergency departments (EDs) annually. These patients are usually treated with nonsteroidal anti-inflammatory drugs, acetaminophen, opioids, or skeletal muscle relaxants, often in combination. Low back pain (LBP) is responsible for 2.4 percent of visits to U.S. emergency departments, resulting in more than 2.5 million visits annually. These patients are usually treated with NSAIDs, acetaminophen, opioids, or skeletal muscle relaxants, often in combination.
This medication should only be used short-term (for 3 weeks or less) unless directed by your doctor. If you notice any other effects, check with your healthcare professional. Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
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Do not start, stop, or change the dosage of any medicines without your doctor’s approval. Cyclobenzaprine is used to help relax certain muscles in your body. It helps relieve pain, stiffness, and discomfort caused by strains, sprains, or injuries to your muscles. However, this medicine does not take the place of rest, exercise or physical therapy, or other treatment that your doctor may recommend for your medical problem. Cyclobenzaprine acts on the central nervous system (CNS) to produce its muscle relaxant effects. Its actions on the CNS may also cause some of this medicine’s side effects.
Three months after the emergency department visit, regardless of study group, opioid use for LBP was uncommon, with fewer than 3 percent of patients reporting use of an opioid within the previous 72 hours. Among patients with acute, non-traumatic, non-radicular low back pain presenting to the ED, adding cyclobenzaprine or oxycodone/acetaminophen to naproxen alone did not improve functional outcomes or pain at 1-week follow-up. There are multiple medications available to treat low back pain in the acute setting. Despite the common use of these medications, the evidence for opioids in the treatment of acute low back pain is very limitedReference Deyo, Von Korff and Duhrkoop 3 . Additionally, existing data comparing the combination of NSAIDs plus muscle relaxants with NSAIDS plus placebo has been conflictingReference Berry and Hutchinson 4
– Reference Pareek, Chandurkar and Chandanwale 8 . We were unable to find high-quality published data that evaluated the efficacy of opioids combined with NSAIDs for acute LBP.
It can also enhance the effects of agents with CNS depressant activity. Older adults appear to have a higher risk for CNS-related adverse reactions, such as hallucinations and confusion, when using cyclobenzaprine. Withdrawal symptoms have been noted with the discontinuation of chronic cyclobenzaprine use.
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Sign up to get tips for living a healthy lifestyle, with ways to fight inflammation and improve cognitive health, plus the latest advances in preventative medicine, diet and exercise, pain relief, blood pressure and cholesterol management, andmore. Additional data for the exploratory outcomes of pain intensity at one week follow-up and resumption of usual activities at three month follow-up are reported in eTable 2 in Supplement 2. Alcohol can increase the nervous system side effects of cyclobenzaprine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with cyclobenzaprine. Do not use more than the recommended dose of cyclobenzaprine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you.
Although not all of these side effects may occur, if they do occur they may need medical attention. It is very important that your doctor check your progress at regular visits. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it. If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Using this medicine with any of the following medicines is not recommended.
Skeletal muscle relaxants are widely used in treating musculoskeletal conditions. However, evidence of their effectiveness consists mainly of studies with poor methodologic design. In addition, these drugs have not been proven to be superior to acetaminophen or nonsteroidal anti-inflammatory drugs for low back pain. Systematic reviews and meta-analyses support using skeletal flexeril.live muscle relaxants for short-term relief of acute low back pain when nonsteroidal anti-inflammatory drugs or acetaminophen are not effective or tolerated. Comparison studies have not shown one skeletal muscle relaxant to be superior to another. Cyclobenzaprine is the most heavily studied and has been shown to be effective for various musculoskeletal conditions.
Available data do not support the superiority of opioids over NSAIDs.19 In this study, oxycodone/acetaminophen + naproxen was not better than placebo + naproxen. We identified a difference in pain outcomes among participants who took oxycodone/acetaminophen more than once when compared with those who took placebo more than once. Furthermore, the magnitude of benefit was modest, with a number needed to treat of nearly 6 for moderate or severe pain, which is balanced by a number needed to harm of nearly 5.
Investigators also asked about any adverse effects at 7 days and 3 months. We aimed to maximize medication use by instructing patients to choose whether to take 1 or 2 tablets of the investigational medication at each dosing, thereby giving the patient the ability to titrate efficacy against adverse effects. Infrequent use of the study medication is both a limitation and strength of this study—it is possible that standing doses of oxycodone/acetaminophen or cyclobenzaprine may have treated the pain and functional impairment more effectively.
