baclofen

[100YardDash]

I know we use baclofen for spasticity, but can and do any of you use baclofen as a muscle relaxant for myofacial back pain?
Which muscle relaxant do you like to use? which muscle relaxant has the least risk for dependency? skelaxin? I was told by one of my attendings that flexeril is a poor choice for myofacial back pain. appreciate your time guys

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[PMR2008]

Soma is the way to go j/k. Baclofen and Tizanidine is better for spasticity. Baclofen is also known to have an intrinsic analgesic efficacy. Stay away from all Benzos of course. Flexeril is structurally similar to tricyclic antidepressants but it has the best evidence for use in cervical and lumbar paraspinal muscle pain. I have had good success with it when using it short term. Some people are very sensitive to it though so I always start low and first start it before bed.

 

[Disciple]

Tizanidine and baclofen are fine may have activity against neuropathic pain. Skelaxin, somewhat less effective though not that sedating. Flexeril is good for spasm/difficulty sleeping.

Avoid Soma and benzos.

 

[Paddington]

To me, spasticity and "muscle spasm" are two completely different things, even though some of the treatments and even ICD code are shared. With pain patients, their muscle spasm tends to be a very subjective phenomenon. Only a minority of them will have true, severe, objective muscle spasm in the back that is likely to respond well to Baclofen. In these cases, even Botox may also be considered.

Baclofen shouldn't be taken PRN, which is how most pain patients want to take muscle relaxants. Depending upon your local population, PRN is often how they will take their meds even if you explain repeatedly/write down/give printouts/translate into their native language about how some of their meds should be taken scheduled and others as needed. To me, Baclofen makes more sense for true spasticity. I stick with Flexeril for pain patients, sometimes Tizanidine.

 

[Jitter Bug]

Myofascial spasms short term:

if they want to sleep better, flexeril qhs. If they want daytime spasm relief, robaxin TID or QID. I rarely go to tizanidine because of extra tracking with LFT's=more work for me.

Long term, I tell them that if they stretch regularly and get off the couch they won't have muscle spasms, so they shouldn't need it long term.

I don't use any benzos or soma for outpatients. I don't use soma at all.

I also save baclofen for true spasticity.