Gabapentin for Chronic Neuropathic Pain and Fibromyalgia

This review is an update of a review published in 2011, itself a major update of previous reviews published in 2005 and 2000, investigating the effects of gabapentin in chronic neuropathic pain (pain due to nerve damage). Antiepileptic drugs are used to manage chronic neuropathic pain and fibromyalgia.

What are the signs and symptoms of fibromyalgia?
What are the signs and symptoms of fibromyalgia?

OBJECTIVES:

To assess the analgesic efficacy and adverse effects of gabapentin in chronic neuropathic pain and fibromyalgia.

SEARCH METHODS:

We identified randomised trials of gabapentin for chronic neuropathic pain or fibromyalgia by searching the databases MEDLINE (1966 to March 2014), EMBASE (1980 to 2014 week 10), and CENTRAL in The Cochrane Library (Issue 3 of 12, 2014). We obtained clinical trial reports and synopses of published and unpublished studies from Internet sources, and searched Clinicaltrials.gov. Searches were run originally in 2011 and the date of the most recent search was 17 March 2014.

SELECTION CRITERIA:

Randomised, double-blind studies reporting the analgesic and adverse effects of gabapentin in neuropathic pain or fibromyalgia with assessment of pain intensity, pain relief, or both, using validated scales. Participants were adults.

DATA COLLECTION AND ANALYSIS:

Three review authors independently extracted efficacy and adverse event data, examined issues of study quality, and assessed risk of bias. We performed analysis using three tiers of evidence. First tier evidence derived from data meeting current best standards and subject to minimal risk of bias (outcome equivalent to substantial pain intensity reduction, intention-to-treat analysis without imputation for dropouts; at least 200 participants in the comparison, 8 to 12 weeks duration, parallel design), second tier from data that failed to meet one or more of these criteria and were considered at some risk of bias but with adequate numbers in the comparison, and third tier from data involving small numbers of participants that were considered very likely to be biased or used outcomes of limited clinical utility, or both.For efficacy, we calculated the number needed to treat to benefit (NNT), concentrating on at least 50% pain intensity reduction, and Initiative on Methods, Measurement and Pain Assessment in Clinical Trials (IMMPACT) definitions of at least moderate and substantial benefit. For harm we calculated number needed to treat for harm (NNH) for adverse effects and withdrawal. Meta-analysis was undertaken using a fixed-effect model. We emphasised differences between conditions now defined as neuropathic pain, and other conditions like masticatory pain, complex regional painsyndrome type 1 (CRPS-1), and fibromyalgia.

MAIN RESULTS:

Seven new studies with 1919 participants were added. Another report (147 participants) provided results for a study already included, but which previously had no usable data. A further report (170 participants) used an experimental formulation of intrathecal gabapentin. Thirty-seven studies (5633 participants) studied oral gabapentin at daily doses of 1200 mg or more in 12 chronic pain conditions; 84% of participants were in studies of postherpetic neuralgia, painful diabetic neuropathy or mixed neuropathic pain. There was no first tier evidence.Second tier evidence for the outcome of at least 50% pain intensity reduction, considered valuable by patients with chronic pain, showed that gabapentin was significantly better than placebo in postherpetic neuralgia (34% gabapentin versus 21% placebo; NNT 8.0, 95% CI 6.0 to 12) and painful diabetic neuropathy (38% versus 21%, NNT 5.9, 95% CI 4.6 to 8.3). There was insufficient information in other pain conditions to reach any reliable conclusion. There was no obvious difference between standard gabapentin formulations and recently-introduced extended-release or gastro-retentive formulations, or between different doses of gabapentin.Adverse events occurred significantly more often with gabapentin. Persons taking gabapentin could expect to have at least one adverse event (62%), withdraw because of an adverse event (11%), suffer dizziness (19%), somnolence (14%), peripheral oedema (7%), and gait disturbance (9%). Serious adverse events (3%) were no more common than with placebo.There were insufficient data for direct comparisons with other active treatments, and only third tier evidence for other painful conditions.

AUTHORS’ CONCLUSIONS:

There was no top tier evidence that was unequivocally unbiased. Second tier evidence, with potentially important residual biases, showed that gabapentin at doses of 1200 mg or more was effective for some people with some painful neuropathic pain conditions. The outcome of at least 50% pain intensity reduction is regarded as a useful outcome of treatment by patients, and the achievement of this degree of pain relief is associated with important beneficial effects on sleep interference, fatigue, and depression, as well as quality of life, function, and work. About 35% achieved this degree of pain relief with gabapentin, compared with 21% for placebo. Over half of those treated with gabapentin will not have worthwhile pain relief. Results might vary between different neuropathic pain conditions, and the amount of evidence for gabapentin in neuropathic pain conditions except postherpetic neuralgia and painful diabetic neuropathy, and in fibromyalgia, is very limited.The levels of efficacy found for gabapentin are consistent with those found for other drug therapies in postherpetic neuralgia and painful diabetic neuropathy.

Gabapentin for Chronic Neuropathic Pain and Fibromyalgia

Study Population: Adults with postherpetic neuralgia or diabetic neuropathy

Efficacy Endpoints: 50% pain intensity reduction

Harm Endpoints: Dizziness, somnolence, ataxia, edema

Narrative: Neuropathic pain, when the pain generator is the nerve itself, occurs in a variety of conditions including diabetes mellitus and postherpetic neuropathy. The exact mechanism of action for these conditions is unclear. Some speculate that aberrant nerve signal modulation may be a culprit, which would explain why neuropathic pain rarely responds adequately to traditional analgesics, and why an effective treatment has proven elusive. Further complicating matters for patients, neuropathic pain typically is chronic in nature. Given the chronic nature and the poorly understood etiology, neuropathic pain is a challenge to treat and to study.

Patients generally consider a 50% reduction in their chronic pain a useful outcome because it has been associated with important beneficial effects on sleep interference and depression.1 Physicians have tried a variety of medicines off-label including opiates, antidepressants, and antiepileptics to relieve patients’ neuropathic pain. One such drug, gabapentin (Neurontin), received approval by the U.S. Food and Drug Administration (FDA) in 1993 as an adjunct medicine for partial seizures and additional FDA approval in 2002 for the treatment of postherpetic neuralgia.2 Gabapentin remains off-label when used to treat diabetic neuropathy.

This summary uses a Cochrane review, updated in 2014, to address the efficacy of gabapentin compared with placebo to palliate neuropathic pain.3 The Cochrane review includes 37 trials enrolling more than 5,600 patients. Overall, there were limited quality data to permit analysis of other neuropathic indications other than postherpetic neuralgia and diabetic neuropathy. Oral gabapentin dosed at 1,200 mg or more daily demonstrated a 50% reduction in pain intensity, with a number needed to treat (NNT) of eight for postherpetic neuralgia and an NNT of six for diabetic neuropathy. Gabapentin treatment was associated with several adverse effects including dizziness (number needed to harm [NNH] = 8), somnolence (NNH = 11), ataxia (NNH = 13), and edema (NNH = 21). There were no obvious differences in patient response with doses greater than 1,200 mg. The NNT for gabapentin is similar to a recent meta-analysis that demonstrated an NNT of seven.4

Caveats: The Cochrane reviewers indicated that high-quality evidence was lacking, which limits the strength of the conclusions and the resulting NNTs in this analysis. Moreover, only postherpetic neuralgia and diabetic neuropathy had been studied adequately to generate numerical estimates for the purposes of this review. Although patients with other neuropathic conditions were included in the Cochrane review, specifically fibromyalgia, the efficacy of gabapentin could not be evaluated in the treatment of these conditions because of a lack of quality data.

The regulatory and research history of gabapentin is important and relevant in any attempt to understand how related data should be applied or extrapolated. There are a number of peer-reviewed publications,5,6,7 publicly available court documents,8 investigative lay press reports,9 and high-profile scientific editorials10 that all strongly suggest that available data on gabapentin cannot be comfortably extrapolated or applied to practice. For this reason, we have rated gabapentin for chronic neuropathic pain yellow, meaning we believe that a proper answer is not yet available. In the future, we hope to see high-quality, randomized, non–industry-funded data that may offer reliable and valid answers to the question of the efficacy of gabapentin for neuropathic pain and other conditions.

There are patients who appear to benefit from gabapentin. This is particularly important in the case of postherpetic neuralgia, which can severely impact quality of life, and psychological and physical well-being.11,12 The challenge is identifying the minority of patients who derive benefit and finding the proper dose,13 both of which seem to depend on patients’ clinical response to a trial of therapy.

Notably, few guidelines exist for the treatment of neuropathic pain. One, from the National Institute for Health and Care Excellence in the United Kingdom, includes the use of gabapentin as a first-tier treatment for all neuropathic pain.14 Similarly, the European Federation of Neurological Societies includes gabapentin as a first-tier agent in its guideline for neuropathic pain, specifically including painful polyneuropathy and postherpetic neuralgia.15 The American Academy of Neurology with other organizations issued a joint guideline in 2011 indicating only that gabapentin should be considered for the treatment of painful diabetic neuropathy.16

The opinions and assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the U.S. Air Force medical department or the U.S. Air Force at large.

The original manuscript was published in Medicine by the Numbers, American Family Physician as part of the partnership between TheNNT.com and AFP.

 

Fibromyalgia-Gabapentin- New study about Brain Fog Occurrence

Research suggests that people with fibromyalgia have too much glutamate in certain parts of their brain, so gabapentin has long been prescribed for it. But is it effective? Research is mixed.

Two reviews of the evidence disagree. One released in 2016 found that gabapentin is an effective fibromyalgia treatment,3 while another, published in 2017,4

A 2014 review of gabapentin for fibromyalgia and neuropathy found that about 35 percent of study participants saw their pain drop by at least 50 percent while on the drug.5 It’s important to note, though, that 21 percent saw similar drops when taking a placebo.

In studies comparing gabapentin with pregabalin (Lyrica), including one published in The Journal of the American Medical Association, pregabalin appeared to perform better.

An extended-release form of gabapentin showed promise in one small trial published in Pain Practice.3 Researchers say it improved pain, sleep, and quality of life. This was a preliminary trial, though, so more work needs to be done before we’ll know for sure whether it’s safe and effective long term.

Many people who suffer from chronic fatigue or Fibromyalgia use prescription drug like Gabapentin (Neurontin) to aid and manage symptoms of pain and epileptic seizure.

the disturbed epileptic seizure results in sleep apnea, sleep dysfunction or restless leg syndrome.

What are the signs and symptoms of fibromyalgia?
What are the signs and symptoms of fibromyalgia?

The new study shows that due to thrombospondin and unnatural function of brain the possible results seen are brain dysfunction. If you are suffering from brain fog related to Fibromyalgia or deficiency of immune system related to chronic fatigue syndrome, then Gabapentin may not be the best choice or first line choice of drug.

It proves to be logical that it adds to the existing symptoms if you continue using this drug (prescription).

Let us know how and why?

By using Gabapentin, you might disturb the important brain connection that is important for you for cognition and proper memory. Most of us are aware of how delicate our brain is. If anything goes wrong with this delicate part of our body, it can be life-threatening. Too much of drug interactions or anesthesia and you might lose your senses. In simple words anything that leaves a negative impact on the normal functioning of our brain should be researched, suspected, avoided and reported, if possible.

New study shows that an individual who is suffering from chronic fatigue syndrome or fibromyalgia can show the following symptoms if using this drug

  • Not able to think properly or not able to think only
  • Couldn’t recollect memories of say a week before even if the brain is recessed.
  • Mentally incapable of thinking even below normal level, unable to think and feel numb.
  • Not being able to do logical reasoning even simple ones like solving a financial problem or not able to judge what needs to be spoken in a discussion.
  • Not able to think or care what will happen in a stressful situation or vice versa like not bothered about what will be the result. This even leads to emotional detachment. These results in like a person who is least bothered about living his life and in turn it creates suicidal thoughts or chronic depression.

Brain fog is a situation that pulls you down and is incredibly tough and scary symptom to handle as compared to other symptoms.

This is something to explain how powerful the drug is and can affect your loved one. If the brain has stopped functioning normally, then how would you know what the reason is or cause behind it?  What might be happening?

So if you notice such symptoms it is better to consult your health care person to take actions immediately. There are many people who lose connection to life while taking the drug and if they get well, they see a new life as the brain becomes functional and live again and body follows the brain.

Make sure you consult your doctor before taking this drug as the symptoms can be scary and you might lose your connection with life. Better start with right medication and speak to your doctor.

Fibromyalgia-Gabapentin- New study about Brain Fog Occurrence

 

List of Common Muscle Relaxers

Muscle relaxers are used in addition to rest, physical therapy, and other measures to relieve discomfort. They are typically prescribed for short-term use to treat acute, painful musculoskeletal conditions. Muscle relaxers are occasionally prescribed for chronic pain (pain lasting longer than 3 months).

Muscle relaxants are medications that help reduce muscle spasms, which are involuntary muscle contractions caused by a spine-related problem, such as whiplash, fibromyalgia, or low back strain. Often, muscle spasms cause severe pain and may limit your mobility.

Product Name Price Shipping Total Order
Cyclobenzaprine (Generic Flexeril 10mg) 180 pills $159 free $159 Order
Zanaflex (Generic Tizanidine ) 4mg – 180 Tabs $156 free $156 Order
Methocarbamol (Gen. for Robaxin) 500mg – 180 Tabs $158 free $158 Order
Generic Fioricet – 180 Tabs $239 free $239 Order
Gabapentin 800 mg – 180 Tabs $189 free $189 Order

Muscle relaxers are not a class of drugs—meaning they do not all have the same chemical structure or work the same way in the brain. Rather, the term muscle relaxer is used to describe a group of drugs that act as central nervous system depressants and have sedative and musculoskeletal relaxant properties.

Muscle relaxers may be prescribed to treat back pain:

      • Early in the course of back pain, on a short-term basis, to relieve pain associated with muscle spasms
      • When back pain causes insomnia (for their sedative effect)

Muscle relaxers are also prescribed for other conditions such as fibromyalgia, multiple sclerosis, and seizure disorders.

There are several types of muscle relaxer medications commonly used to treat back pain.

muscle relaxant
muscle relaxant

Common Muscle Relaxants

Muscle relaxers are usually prescribed to treat back pain in conjunction with rest and physical therapy. Common muscle relaxants include:

      • Baclofen. Muscle tightness and muscle spasms, including those related to spine injuries, may be eased with baclofen. The medication may be helpful in treating multiple sclerosis and stabbing nerve pain. It is available as a tablet and can be taken by children as young as 12 years old. Some common side effects could include nausea and vomiting, confusion, drowsiness, headache, or muscle weakness. Baclofen is rated C in the FDA’s A through X pregnancy safety ranking for medications, with A being the safest. The C category means that the medication should only be used if the benefits outweigh the risks.
      • Benzodiazepines. In addition to treating anxiety, alcohol withdrawal, and seizure disorders, such as epilepsy, benzodiazepines can also treat muscle spasms and skeletal pain. Benzodiazepines, such as diazepam (Valium), lorazepam (Ativan), and temazepam (Restoril), are typically only intended for short-term use. This limitation is due to their habit-forming potential and because they alter sleep cycles, leading to sleep difficulties once the drug is stopped. Benzodiazepines are sold as tablets, liquid, injections, and rectal gels. People who have myasthenia gravis, severe liver disease, serious breathing troubles, or some forms of glaucoma, should avoid taking diazepam. All benzodiazepines are rated D by the FDA for safety during pregnancy and are not recommended for women who are pregnant.
      • Carisoprodol (Soma). Carisoprodol relaxes muscles and eases pain and stiffness caused by acute bone and muscle problems, often caused by an injury. It is taken by mouth in tablet form and is also available in combination with aspirin or aspirin and codeine. Carisoprodol can be habit-forming, particularly if used in conjunction with alcohol or other drugs that have a sedative effect, including opioids (such as codeine). Common side effects include drowsiness, dizziness, and headache. People with a history of blood disorders, kidney or liver disease, and seizures may need to avoid Carisoprodol. It is rated C in the FDA’s pregnancy safety ranking for medications.
      • Chlorzoxazone (Lorzone). Chlorzoxazone is used for the relief of discomfort from acute, painful, musculoskeletal conditions. Chlorzoxazone is available as a tablet. Common side effects include drowsiness, dizziness, and nausea. Chlorzoxazone is not recommended for people with liver disease. It has not been rated by the FDA for safety during pregnancy.
      • Cyclobenzaprine (Amrix, Fexmid, FlexePax Kit, FusePaq Tabradol). Cyclobenzaprine eases stiffness and pain from muscle cramps, also called muscle spasms. It is available as a tablet and extended-release capsule. Cyclobenzaprine itself is not intended for long-term use (more than 2 to 3 weeks). Common side effects include blurred vision, dizziness or drowsiness, and dry mouth. It is not advised for those with an overactive thyroid, heart problems, or liver disease. Cyclobenzaprine is rated B by the FDA for safety during pregnancy, making it the safest muscle relaxant to use while pregnant.
      • Dantrolene (Dantrium). Dantrolene helps control chronic spasticity related to spinal injuries. It is also used for conditions such as stroke, multiple sclerosis, and cerebral palsy. Dantrolene is taken as a capsule or intravenous powder for injection. Drowsiness and sensitivity to light are common side effects. It can cause severe liver problems, and should not be taken by people with active liver disease. The FDA has given dantrolene a C rating for safety in pregnancy.
      • Metaxalone (Skelaxin, Metaxall, and Metaxall CP, Lorvatus PharmaPak). Metaxalone targets pain and muscle spasms from sprains, strains, and muscle injuries. It is available as a tablet or injection. Common side effects include drowsiness, dizziness, nausea, and vomiting. Metaxalone is generally not recommended for people with a known tendency to become anemic, and who have kidney or liver disease. Metaxalone may affect blood sugar tests for people with diabetes. The FDA has not rated metaxalone for safety during pregnancy.
      • Methocarbamol (Robaxin, Robaxin-750). Methocarbamol eases acute muscle and bone pain. It can be taken as a tablet or by injection. Common side effects include dizziness, headache, nausea, flushing, and blurred vision. Methocarbamol is generally not recommended to people with renal disease or failure, or a history of allergic reaction to the medication. The FDA has given methocarbamol a C rating for safety during pregnancy.
      • Orphenadrine. Orphenadrine is a medication used to relieve pain and stiffness caused by muscle injuries. It is available as an extended-release tablet. Common side effects include dry mouth, lightheadedness, difficult urination, heartburn, nausea and vomiting. It is generally not recommended to people with previous sensitivities to the ingredients, myasthenia gravis, those with glaucoma or certain types of ulcers. The FDA has given orphenadrine a C rating for safety during pregnancy.
      • Tizanidine (Comfort Pac with Tizanidine, Zanaflex). Tizanidine is used to treat muscle spasms caused by spinal cord injuries and other conditions such as multiple sclerosis. Tizanidine is available in tablet and capsule form and absorbs differently depending on whether it is taken on an empty stomach or with food. Common side effects include dry mouth, dizziness, constipation and tiredness. It should not be used by people taking fluvoxamine or ciprofloxacin or those who have liver disease. Tizanidine is rated in the C category for safety during pregnancy.

Sometimes the first muscle relaxers a doctor prescribes does not work as well as expected. It may be necessary to try an alternative if the initial prescription is not effective. Many drugs interact with muscle relaxers and a person should keep their health care provider informed of all prescription and non-prescription medications he or she is taking.

There is very little research regarding which muscle relaxers are most effective, so the choice of which medication—or whether to use one at all—is based on factors such as a person’s reaction to the medication and personal preferences, potential for abuse, possible drug interactions, and adverse side effects.

9 popular muscle relaxants. How well do they work and what are their side effects? Oh, and are they affordable?

1) Methocarbamol

Methocarbamol (Robaxin) is a well-studied medication that treats back pain. It’s also inexpensive and relatively less sedating than other options. In recent studies where it was used for up to 8 days, 44% of folks that took methocarbamol had complete pain relief (compared to 18% who took nothing) — and that was without any serious side effects.

Taken as needed, 1500 mg every 6 to 8 hours is a cheap and well-tolerated option for sufferers of acute neck and back pain. Think of trying this first, as it is less sedating than other options, like cyclobenzaprine and carisoprodol.

2) Cyclobenzaprine

At the standard dose of 10 mg to 30 mg a day, cyclobenzaprine (Flexeril) will make you sleepy. If you use it during the day, you’ll want to break your 10 mg tab in half and take 5 mg to lessen the drowsiness. Interestingly, 5 mg three times a day has been shown in studies to work as well as 10 mg taken 3 times a day.

Cyclobenzaprine is a reasonable first choice because it’s a cheap generic, but the sedation side effect limits its use during the day. It may also cause more dry mouth, especially in older folks. If this is a concern, consider a better non-sedating option.

3) Carisoprodol

Carisoprodol (Soma) is a Schedule IV drug (similar to benzodiazepines Ativan, Valium, and Xanax) and has the potential for being abused. For this reason, you should not use it if you have a history of substance abuse.

Many believe that carisoprodol should be phased out as a muscle relaxant in favor of much better options. If prescribed, you should only use it for short periods of 2 to 3 weeks due to lack of evidence for effectiveness with longer use. It may cause drowsiness and dizziness, and it should not be used in folks over 65.

Taken as 800 mg tablets 3 to 4 times a day, metaxalone (Skelaxin) has the fewest reported side effects and lowest sedation potential of the muscle relaxants based on clinical studies. Simply put, it is the best-tolerated of the muscle relaxants.

Metaxolone is a generic alternative for the brand drug Skelaxin, but it is still pricey. Insurance companies don’t like to cover it because there are cheaper alternatives. Having said that, it works as well as cyclobenzaprine and carisoprodol with fewer side effects and less sedation—so paying cash may be worth it.

5) Tizanidine

Tizanidine (Zanaflex) is often used for spasticity in patients with multiple sclerosis or cerebral palsy. Spasticity is where the muscles undergo continuous contraction, which leads to tightness and stiffness. In head-to-head studies with Baclofen for those conditions, tizanidine tends to have fewer side effects — but they both work just as well. This is not a first-line choice for acute neck or back muscle pain, though.

6) Baclofen

Similar to tizanidine, Baclofen is primarily used for spasticity in spinal cord injury patients or those with multiple sclerosis. Up to 20% of folks taking it have drowsiness, and there are better options for neck and back muscle pain. Also not a first choice.

7) Oxazepam and diazepam

Benzodiazepine medications like oxazepam and diazepam (Valium) are sometimes prescribed as muscle relaxants. However, these really aren’t recommended because they don’t work well, are sedating, and can be habit-forming. Avoid benzodiazepines for neck and back muscle pain because there are much better options.

8) Chlorzoxazone

Chlorzoxazone (Lorzone) is not well-studied for acute low back and neck pain in adults. And when investigated for pain after spine surgery, it wasn’t found to be effective. Chlorzoxazone has also been reported as a rare cause of acute liver toxicity. Don’t choose this until you’ve exhausted all other options.

9) Orphenadrine

For neck and back pain in adults, the first 4 medications on this list work better than orphenadrine (Norflex), so save this as another last resort in the event the others don’t work. It just hasn’t been well studied for this purpose.

Muscle Relaxants for Muscle Spasms

Muscle spasms are painful and may restrict mobility, which can limit your ability to perform even basic activities. Painful, tight muscles can also interfere with getting a good night’s sleep.

Muscle relaxants may help reduce pain, and improve movement and range of motion, but your doctor will likely recommend that you first try acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID). In some cases, these over-the-counter medications will be enough to help alleviate your pain.

If your muscle pain persists, your doctor may prescribe a muscle relaxant in addition to your pain medication. Below are common muscle relaxants (the generic names are listed first, with a brand name example in parentheses):

  • Baclofen (Lioresal)
  • Carisoprodol (Soma)
  • Cyclobenzaprine (Amrix)
  • Metaxalone (Skelaxin)
  • Methocarbamol (Robaxin)

Special Considerations and Potential Muscle Relaxant Side Effects

Muscle relaxants for acute back or neck pain are usually prescribed to relieve short-term muscle pain—and some can be habit-forming. For these reasons, most doctors will write prescriptions with less than 2 weeks’ worth of medication. To reduce your risk of dependency or abuse, use your medication exactly as your doctor prescribes.

The most common side effects associated with muscle relaxants are drowsiness and dizziness. This is because muscle relaxants depress your central nervous system, making you less alert and attentive. As such, avoid alcohol and don’t perform tasks that require your complete attention, such as operating machinery or driving, while taking a muscle relaxant.

Muscle relaxants pose health risks when they are taken with certain medications and supplements, including opioids, sleep aid medications, and St. John’s wort. Make sure your doctor knows every medication and supplement you are taking before starting muscle relaxant therapy.

Muscle Relaxants: Part of a Multidisciplinary Treatment Plan

If your muscle pain doesn’t respond to over-the-counter medications, then muscle relaxants may be a good treatment option to alleviate your muscle spasms. For best results, muscle relaxants should be viewed as part of a treatment plan that may include gentle stretching, physical therapy, and exercise—not the sole treatment. As always, don’t hesitate to discuss your medications and comprehensive spine health plan with your doctor. A solid understanding of your therapeutic options is a strong defense against back pain.