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Cyclobenzaprine in the Treatment of Low Back Pain

 


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Am Fam Physician. 2016 Feb 1;93(3):online.

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CYCLOBENZAPRINE (FLEXERIL) FOR LOW BACK PAIN

Number needed to treat = 3 to experience global improvement in symptoms at 10 days
Number needed to harm = 4 to cause adverse effects (drowsiness, dry mouth, dizziness, and nausea)
BenefitsHarms

Global improvement in back pain symptoms

Medication adverse effects (drowsiness, dry mouth, dizziness, and nausea)

CYCLOBENZAPRINE (FLEXERIL) FOR LOW BACK PAIN

Number needed to treat = 3 to experience global improvement in symptoms at 10 days
Number needed to harm = 4 to cause adverse effects (drowsiness, dry mouth, dizziness, and nausea)
BenefitsHarms

Global improvement in back pain symptoms

Medication adverse effects (drowsiness, dry mouth, dizziness, and nausea)

Details For This Review

Study Population: Adults with uncomplicated low back pain

Efficacy End Points: Global improvement in symptoms by day 10 of treatment

Harm End Points: Drowsiness, dry mouth, dizziness, nausea

Narrative: The muscle relaxant cyclobenzaprine (Flexeril) is a common medication for low back pain that is used to reduce muscle spasm as an adjunct to pain control with nonnarcotic analgesics. Multiple reviews exist on this topic, including three we consider to be of relatively good quality, although with differing emphases. One is a Cochrane review that pools nonbenzodiazepine drugs together for analysis1; a second conducted for a joint clinical guideline from the American Pain Society and the American College of Physicians2; and the third is a comprehensive examination of cyclobenzaprine performed by an independent author group.3 This latter review, published in 2001, examined 14 publications (n = 2,440) comparing cyclobenzaprine with placebo, and was used as the basis for the joint clinical guideline; thus, we have concentrated on this study as our primary source for this summary.

In pooled analyses, treatment with cyclobenzaprine was more likely than placebo (odds ratio = 4.7; 95% confidence interval [CI], 2.7 to 8.1) to result in global impr

Author disclosure: No relevant financial affiliations.

REFERENCES

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1. van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low back pain. Cochrane Database Syst Rev. 2003;(2):CD004252....

2. Chou R, Huffman LH; American Pain Society; American College of Physicians. Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline [published correction appears in Ann Intern Med. 2008;148(3):247–248]. Ann Intern Med. 2007;147(7):505–514.

3. Browning R, Jackson JL, O'Malley PG. Cyclobenzaprine and low back pain: a meta-analysis. Arch Intern Med. 2001;161(13):1613–1620.

4. Friedman BW, Dym AA, Davitt M, et al. Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain: a randomized clinical trial. JAMA. 2015;314(15):1572–1580.



 

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