Muscle relaxers no solution to persistent back pains

Back pain is among the major causes of physical discomfort, suffering and disability among Kenyans.

Sometimes, the pain presents as a dull ache that is manageable. Another time the pain is excruciating, preventing easy movement and doing daily chores.

Those with severe back ache usually flock to hospitals seeking urgent remedy.

Since most back pains are caused by stiff muscles, it is common practice for health practitioners to prescribe muscle relaxers.

These drugs usually work for some people but may remain ineffective for many more who continue to grapple with the condition and the adverse effects.

Mercy, a 35 year-old customer care agent in Nairobi, has seen it all. She has been nursing back pains for more than five years.

"I think the pain began as a result of all the standing I would do in my company, waiting on guests and distributing brochures. When not doing that, I would be seated at my desk all day long, picking calls and making hotel bookings," she says.

To find a solution, Mercy sought help at a nearby health facility and she was referred to an orthopaedic doctor.

"After assessing the situation and having an X-ray of the back done, I was informed that the standing and sitting for long in bad posture had tightened the back muscles, leading to the pain I was feeling," she says.

Mercy eventually got muscle relaxers as prescription that though helpful, have not saved her from the pains. This has forced her to look for alternatives.

It is the experience of such patients that began planting seeds of doubt among health practitioners and researchers about the effectiveness of muscle relaxers on alleviating body pains caused by muscle strains.

A new study published in the British Medical Journal offers fresh insights into the matter. It indicates that muscle relaxers may be largely ineffective for low back pain, despite being widely prescribed for this condition.

The findings show that the drugs might relieve pain in the short term, but their impact is perceived to be minimal. And they come with an increased risk of side effects such as dry mouth, drowsiness, dizziness, weakness, irritability, confusion, stomach problems and low blood pressure.

DISABILITY CHALLENGES

During the study, the researchers investigated the effectiveness, acceptability, and safety of muscle relaxers compared with placebo, usual care, or no treatment in adults with non-specific low back pain.

They did this by reviewing and carrying out a detailed analysis of evidence from 31 research trials, involving more than 6,500 participants that focused on the effect of muscle relaxers on back pain.

The results of the study showed that the drugs might reduce pain intensity at two weeks or less for patients with acute low back pain.

But the effect was found to be small — less than eight points (on a zero to 100-point scale).

The researchers, therefore, noted that the effects of the drugs do not meet common thresholds to be considered as clinically meaningful.

This means they did not have real noticeable effect among a majority of people with back pain that took them.

Indeed, further analysis revealed that beyond the initial two weeks, the muscle relaxers had little or no effect on pain levels.

They were also unable to effectively address disability or mobility challenges caused by back pains that prevent people from undertaking daily activities comfortably.

The evidence also showed that the muscle relaxers could increase the risk of side effects among those that take them.

But they can be easily withdrawn without causing any major impact on the treatment progress of the condition.

Even though the research was based on high quality data, the researchers note that the certainty of the evidence was not high enough to allow for firm recommendations.

They note that large trials are urgently needed to resolve uncertainties around the use of these drugs for back pain.

NATURAL REMEDIES

In the meantime, they note that health practitioners should consider the uncertainties surrounding the drugs as they handle back pain cases.

"We would encourage clinicians to discuss this uncertainty in the efficacy and safety of muscle relaxers with patients, sharing information about the possibility for a worthwhile benefit in pain reduction but increased risk of experiencing side effects, to allow them to make informed treatment decisions," they write.

Those keen on avoiding muscle relaxers can embrace natural remedies for addressing back pain such as massage treatment that helps the body to release endorphins or ‘feel good hormones’ that act as pain relievers.

General aerobic exercises such walking and swimming can also come in handy.

In addition, certain targeted stretching exercises can also help to alleviate the pain and strengthen back muscles, hence preventing future cases of pain.

They include the pelvic tilt, trunk rotation, knee-to-chest stretches, flexion rotation, belly flops, cat-cow stretches and press-up back extensions.

Research shows that exercise also increases blood flow to the lower back area, which may reduce stiffness and speed up healing.