- Muscle Relaxants for Back Pain and Neck Pain
- What is the best muscle relaxer?
- What is the best over-the-counter (OTC) medicine for muscle pain?
- What are the best prescription muscle relaxers?
- What is the best natural muscle relaxer?
- Skeletal muscle relaxants
- What are skeletal muscle relaxants used for?
- What are the differences between skeletal muscle relaxants?
- Are skeletal muscle relaxants safe?
- What are the side effects of skeletal muscle relaxants?
- Medications for Neck Pain Relief
- Sciatica: Management and Treatment
- Nonsurgical Treatments
- What is a Pinched Nerve?
- Pinched Nerve Causes and Risk Factors
- Pinched Nerve Symptoms
- Pinched Nerve Treatment Options
- Nonsurgical Treatments for Herniated Disc
- Using Muscles Relaxants To Treat Neck Pain
- Side Effects of Muscle Relaxers
- What are Muscle Relaxers?
- Muscle Relaxer Abuse
- Alcohol and Muscle Relaxers
- Withdrawal and Treatment
Muscle Relaxants for Back Pain and Neck Pain
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.
Your doctor may prescribe a muscle relaxant to ease muscle spasms, reduce pain, and help your muscles move better. When your muscles move better, it makes other spine pain treatments, such as physical therapy, stretching, and exercise, more effective.
Spasms are localized and occur because of a musculoskeletal issue. Photo Source: 123RF.com.
Understanding Spasticity Versus Spasm
Muscle relaxants treat 2 conditions: spasticity and spasm. Spasticity is marked by long-term muscle contraction caused by a brain or spinal cord injury. Spasms, on the other hand, are localized and occur because of a musculoskeletal issue.
Prescription muscle relaxants fall into 2 groups: antispastics and antispasmodics.
- Antispastics are prescribed to treat spasticity caused by neurological disorders, such as cerebral palsy or spinal cord injury.
- Antispasmodics are used to treat occasional muscle spasms.
While some antispasmodics may treat spasticity in addition to spasms, antispastics should not be used to treat spasms.
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.
Back Pain: Finding Solutions for Your Aching Back. A Harvard Medical School Special Health Report. Boston, MA: Harvard Medical School; 2014. Accessed July 20, 2017.
What is the best muscle relaxer?
So, you sprained your lower back shooting hoops, a stressful work week spurred on a series of tension headaches, arthritis has you waking up with stiffness and neck pain. Now what? Tense, aching muscles can be frustrating, distracting, and throw a wrench into your schedule. When muscle pain hits, it can have you looking for fast-acting relief so you can get on with life. Whether you experience back pain, muscle spasms, arthritis, or injury-related chronic pain, muscle relaxers offer fast pain relief, allowing your body to function as usual. Consider this guide your roadmap to the top muscle relaxers on the market.
It’s difficult to declare one muscle relaxant better than all others because each type has its own advantages and uses. In general, pain relief treatments fall into one of three categories: over-the-counter (OTC), prescription, and natural. Determining the best muscle relaxer depends entirely on your specific condition and pain level. When in doubt, consult your healthcare provider.
Over-the-counter remedies: OTC pain relievers are often the first line of defense against pain, inflammation, and tension. They can work wonders for milder conditions like neck and lower back pain. Typically, your doctor might start you out on an OTC medication, and if that doesn’t provide the relief you need, he or she may write a prescription for something higher-grade.
Prescription drugs: For more chronic pain and conditions where OTC medications just won’t cut it, your doctor may prescribe something stronger. Because of their more serious side effects, prescription muscle relaxers are designed for short-term use, after which your doctor will transition to other drugs or treatments.
Natural remedies: For minor soreness and stress-related symptoms, the only treatment you need might be drawn straight from nature. Before rushing off to the doctor for an examination and potential prescription, you might be able to administer an effective plant-based therapy right from home.
What is the best over-the-counter (OTC) medicine for muscle pain?
These are the medications that you can find while perusing the aisles at your local pharmacy or convenience store. Most of them are household names, and it’s not uncommon to keep them on hand, stashed in a medicine cabinet, just in case. Even though OTC medications are easy to obtain, they’ll do the job for many aches and pains, and doctors often recommend them prior to prescribing stronger treatment options.
“OTC NSAIDS, like ibuprofen and naproxen, are a good first line agent to decrease inflammation surrounding an injury,” recommends Joanna Lewis, Pharm.D., creator of The Pharmacist’s Guide. They might not have the same potency of high-grade muscle relaxants, but they’re still effective and have very few side effects. If you roll your ankle at the gym or wake up with back pain, try one of these before asking your doctor for a prescription.
- Advil (ibuprofen): This is a staple of parents, doctors, and athletes alike. Ibuprofen is one of the most widely used nonsteroidal anti-inflammatory drugs (NSAIDs) available. As such, Advil doesn’t just remedy pain, but also inflammation as well. It’s highly versatile. Use it to treat low back pain, osteoarthritis, menstrual cramps, fever, headaches, migraines, sprains, and other minor injuries. Low doses are available over the counter, but a doctor can prescribe higher doses as well.
- Motrin IB (ibuprofen): Don’t be fooled by the different brand name. Motrin IB and Advil are the same drug. Therefore, they shouldn’t be taken together, as it could increase the risk of overdose.
- Aleve (naproxen): Another medicine cabinet staple, naproxen is similar to ibuprofen in many ways. It’s also an NSAID, so it works by reducing inflammation. It’s useful in treating muscle pain, headaches, migraines, osteoarthritis, fever, cramps, and minor injuries. The main difference between naproxen and ibuprofen is their dosing. You can take naproxen every eight to 12 hours and ibuprofen every four to six, so Aleve is slightly longer-lasting.
- Aspirin: One more NSAID for you. Aspirin treats many of the same conditions, relieving pain and reducing inflammation. However, daily doses of aspirin have been proven effective at reducing the risk of blood clots, strokes, and heart attacks in some people. Ask your doctor before using for clot prevention. If you’re a candidate, you will likely take a “baby” aspirin, or 81 mg, coated tablet daily. Common brand names include Bayer or Ecotrin.
- Tylenol (acetaminophen): Unlike NSAIDs, acetaminophen focuses solely on treating pain—not inflammation. It’s used for muscle aches, headaches, migraines, back and neck pain, fevers, etc. However, if swelling and inflammation is the underlying cause of your pain, acetaminophen will not be nearly as effective as NSAIDs like those listed above. Acetaminophen’s wide range of uses and relatively few side effects make it the most popular OTC pain reliever worldwide.
What are the best prescription muscle relaxers?
There are certain times when over-the-counter medications simply aren’t enough. If you’ve been taking acetaminophen or ibuprofen consistently but are still dealing with back pain, spasms, or other issues, it might be time for something more robust. In cases like these, doctors may look to prescription muscle relaxants as a more effective, albeit temporary, answer.
“A pulled back muscle or neck pain may require a doctor’s visit or other diagnostic tests to get to the heart of the issue,” Dr. Lewis says. “There are several good prescription medications like methocarbamol, cyclobenzaprine, and metaxalone.”
Recent studies have shown that skeletal muscle relaxants (SMRs), or antispasmodics, outperform anti-inflammatory drugs (NSAIDs), like ibuprofen and acetaminophen, in relieving severe pain associated with conditions like acute back pain. On the flip side, they also have potentially more serious side effects and shouldn’t be used for long-term pain management. Even so, these prescription drugs are effective and reliable options for short-term pain relief:
- Flexeril or Amrix (cyclobenzaprine): Cyclobenzaprine is a popular and relatively inexpensive generic muscle relaxant often used short-term to treat muscle spasms and pain related to sprains, strains, etc. A typical dose is 5 to 10 mg at bedtime for two to three weeks, although your doctor might approve up to 30 mg daily (taken as one 5 or 10 mg tablet every eight hours) if your case is more severe. Side effects include drowsiness, dry mouth, dizziness, and fatigue.
- Robaxin (methocarbamol): Commonly used to treat severe muscle spasms, back pain, and occasionally tetanus spasms, methocarbamol is administered orally in up to 1500 mg doses or intravenously in 10 ml of 1000 mg. This dosing is usually higher in the first 48 to 72 hours, then decreased. Patients may experience drowsiness, dizziness, blurred vision and—in intravenous doses—reactions at the injection site. However, it’s generally less of a sedative than most other muscle relaxants.
- Skelaxin (metaxalone): While it’s slightly more expensive than other SMRs, like methocarbamol, the upside of metaxalone is that it delivers the same effectiveness with a relatively low rate of side effects. In three to four 800 mg doses per day, it acts on your central nervous system (brain and spinal cord) and may cause drowsiness, dizziness, irritability, and nausea, but metaxalone doesn’t sedate as heavily as the alternatives.
- Soma (carisoprodol): Similar to Robaxin, Soma is generally used to treat pain associated with acute musculoskeletal conditions. Carisoprodol acts on the central nervous system to intercept neurotransmitters relayed between the nerves and brain. It’s administered in 250-350 mg doses three times per day (and at bedtime) for up to three weeks. Common side effects include drowsiness, dizziness, and headaches. It has also been associated with addiction, so it should be used with caution.
- Valium (diazepam): Most often, you’ll hear about Valium as a treatment for anxiety disorders and alcohol withdrawal symptoms, but it can also be an effective medication for muscle spasms. Diazepam is a benzodiazepine (like Xanax) that decreases the sensitivity of certain brain receptors. Dosage varies depending on the condition, but for skeletal muscle spasms, it’s typically 2-10 mg, three or four times per day. Because it slows down brain activity, Valium frequently causes fatigue and muscle weakness so, like other muscle relaxants, you shouldn’t combine it with alcohol or other drugs.
- Lioresal (baclofen): Unlike the muscle relaxants above it on this list, baclofen is primarily used to treat spasticity (continuous muscle tightness or stiffness) caused by multiple sclerosis or spinal cord injury. It is given as an oral tablet, or can be injected into the spinal theca. Most often, baclofen is prescribed on a schedule that increases the dosage gradually every three days. It can cause sleepiness, dizziness, nausea, hypotension (low blood pressure), headache, convulsions, and hypotonia (weak muscle tone), so even though it’s effective for spasticity treatment, it might not be the best option for pain relief.
- Lorzone (chlorzoxazone): This is yet another SMR that acts on the central nervous system to treat the pain and spasms associated with muscle and bone conditions. It’s fairly well-tolerated despite occasional drowsiness, dizziness, lightheadedness, and malaise. In rare cases, it can cause gastrointestinal bleeding, so doctors will often opt for other medications. Typical dosage is 250 to 750 mg three or four times daily.
- Dantrium (dantrolene): Similar to baclofen, dantrolene is primarily used to treat spasticity. It’s effective for spasms associated with spinal cord injury, stroke, cerebral palsy, or multiple sclerosis, and is also sometimes used for malignant hyperthermia. Common side effects include diarrhea, drowsiness, dizziness, fatigue, and muscle weakness. The starting dosage is 25 mg daily and it can be increased slowly if needed, up to 100 mg three times daily. In rare cases of overuse or long-term use, it has been attributed to liver damage.
- Norflex (orphenadrine): In addition to treating injury-related pain and spasms, orphenadrine is also effective in relieving the trembling from Parkinson’s disease. Some patients may experience dry mouth along with heart palpitations, blurred vision, weakness, nausea, headache, dizziness, constipation, and drowsiness, but usually only with increased dosages. However, this muscle relaxant can sometimes cause anaphylaxis, a type of severe allergic reaction. So, for basic muscle pain, doctors often go with one of the other options on this list. Standard dosing is 100 mg, twice per day.
- Zanaflex (tizanidine): Tizanidine is primarily used to treat stiffness and spasms associated with multiple sclerosis and cerebral palsy, similar to baclofen. Both show effectiveness, although tizanidine sometimes shows fewer side effects, which can include dry mouth, tiredness, weakness, dizziness. It’s administered in 2 or 4 mg doses.
What is the best natural muscle relaxer?
Let’s say your pain is lifestyle-related. Maybe a new workout routine put you through the wringer, or slouching over your laptop has started to take its toll on your back and neck. Minor soreness or aches happen all the time for any number of reasons, and they might not be severe or chronic enough to warrant muscle relaxers or other pain relievers. The good news is that there are plenty of natural remedies and dietary solutions to mild body pain. Even better is that you can find most of these treatments in food and supplements.
Dr. Lewis considers certain natural remedies ideal for stress management or to supplement other treatments. “Lavender oil and chamomile are great ingredients for relaxation when taking a bath or getting ready for bed,” she says. “They aren’t usually a first-line treatment but are great in conjunction with other things to manage tension from stress.”
CBD oil (cannabidiol) has been a popular but widely-debated natural supplement. Extracted from the hemp plant, it doesn’t cause a “high,” but it can be effective in treating epilepsy, anxiety, and general pain, among other ailments. Many swear by it for a broad scope of conditions, but research is currently ongoing as to what else it can do.
Additionally, the Food and Drug Administration (FDA) has only approved one CBD product, Epidiolex, which may be prescribed to treat two rare forms of epilepsy. “Many are not regulated, the effectiveness between products is not consistent,” Dr. Lewis explains.
Or, you may have heard of arnica gel, made from an herb native to central Europe. It’s commonly used to treat injury-related pain and swelling and arthritis. Like CBD, there isn’t extensive research on it yet, but arnica has shown promise as a natural pain remedy.
Going the natural route? These natural muscle relaxants can promote pain-free living and holistic health:
|Natural Remedy||Administration Route||Common Treatments|
|Chamomile tea||Oral||Anxiety, inflammation, insomnia|
|CBD oil||Oral, topical||Epilepsy, anxiety, chronic pain|
|Arnica gel||Topical||Osteoarthritis, muscle aches/soreness|
|Cayenne pepper||Oral, topical||Stomach pain, joint pain, heart conditions, cramps|
|Lavender oil||Topical||Anxiety, insomnia, general pain relief|
|Magnesium||Oral||Muscle cramps, indigestion, constipation|
|Lemongrass||Oral, topical||Stomach ache, digestive tract spasms, rheumatoid arthritis|
|Turmeric||Oral||Osteoarthritis, indigestion, abdominal pain|
|Massage, physical therapy||Topical||Muscle pain, soreness, stress, anxiety|
While this list isn’t exhaustive, it presents you with plenty of options, no matter what has you hurting. As always, consult your healthcare provider for professional medical advice before taking a new medication. Even natural treatments can cause serious drug-drug interactions.
Skeletal muscle relaxants
Skeletal muscle relaxants are drugs that are used to relax and reduce tension in muscles. They are more simply referred to as muscle relaxants.
Some work in the brain or spinal cord to block or dampen down excessively stimulated nerve pathways. These are called centrally acting muscle relaxants and examples include baclofen, methocarbamol, and tizanidine.
Others act directly on muscle fibers and are classified as peripherally acting muscle relaxants. Examples include dantrolene and the different types of botulinum toxin. Although dantrolene acts directly on the muscle itself, it also appears to indirectly act on the central nervous system and can cause drowsiness.
Cannabis extract also has muscle relaxing properties and is thought to act both centrally and peripherally.
What are skeletal muscle relaxants used for?
Skeletal muscle relaxants are mainly used to treat:
- spasticity, which is another term for stiff and rigid muscles caused by conditions such as cerebral palsy, multiple sclerosis, or stroke
- muscle spasms which are temporary muscular contractions that are often associated conditions such as tension headache, low back pain, or fibromyalgia
- cervical dystonia – a painful condition where the neck muscles involuntarily contract, causing your head to uncontrollably tilt forward or backward.
What are the differences between skeletal muscle relaxants?
Skeletal muscle relaxants differ in the way they work (centrally or peripherally as discussed above), their side effects, and their effectiveness for certain conditions.
Note that several other medicines, notably diazepam, may also be used as a muscle relaxant and are not listed below.
|Generic name||Brand name||FDA approval (spasm-related)|
|abobotulinumtoxinA||Dysport||Cervical dystonia, Muscle spasms|
|baclofen||Gablofen, Lioresal||General spasticity|
|carisoprodol||Soma, Vanadom||Muscle spasms|
|cyclobenzaprine||Amrix, Flexeril, Fexmid||Muscle spasms|
|onabotulinumtoxinA||Botox||Cervical dystonia, Muscle spasms|
Are skeletal muscle relaxants safe?
Evidence supporting the effectiveness of skeletal muscle relaxants for muscle spasm is sparse; most trials are old and not of good quality. Skeletal muscle relaxants consist of a varied range of medicines and some may not be suitable for people with certain medical conditions such as an enlarged prostate, epilepsy, glaucoma, intestinal problems, liver or kidney disease, or myasthenia gravis. Many also interact with other medications.
Some, like dantrolene, can adversely affect the liver and blood samples should be taken before treatment to check for any pre-existing liver disease or to establish how well the liver is functioning before treatment, and what effect the drug subsequently has.
Muscle relaxants can affect overall muscle tone and may be dangerous if muscle tone is needed for safe balance or movement. Alcohol can enhance these effects. Many muscle relaxants need to be tapered off slowly, rather than abruptly stopped.
What are the side effects of skeletal muscle relaxants?
Drowsiness is common, particularly with centrally acting muscle relaxants; however, drowsiness can occur with some peripherally acting muscle relaxants, such as dantrolene, as well. This may impair the ability of a person to drive or operate machinery or perform hazardous tasks.
Some may also cause side effects such as a dry mouth, fast heartbeat, gastrointestinal upset (such as nausea, vomiting, constipation), headache, insomnia, light headedness, problems with urination, and other unwanted effects.
Products containing botulinum toxin may cause generalized muscle weakness, vision changes, breathing difficulties and other serious side effects if the toxin spreads from the area of injection.
Medications for Neck Pain Relief
Along with rest and physical therapy, medication is often one of the first ways to treat neck pain. There are many different drugs available, and which one to use will depend on the source of your neck pain. For example, a drug designed to treat neck pain caused by a pinched nerve may not work for pain from a muscle spasm or inflammation.
Pain Relief: Acetaminophen and NSAIDs
These over-the-counter medications are considered the first line of attack for most neck pain. They are effective against neck pain caused by muscle and joint problems, such as muscle strains or osteoarthritis.
- Acetaminophen (such as Tylenol) is effective as a pain reliever, but will not improve inflammation, the source of neck pain due to conditions like arthritis of the joints of the vertebrae.
- Nonsteroidal anti-inflammatory drugs, or NSAIDs, like ibuprofen (such as Advil) and naproxen (such as Aleve) relieve pain and reduce swelling by inhibiting the body’s inflammatory response. However, side effects include gastric bleeding, stomach pain, longer time for blood clotting if you are bleeding, hypertension, and fluid retention.
Pain Relief: Opioids
An opioid may be prescribed for more severe neck pain that can’t be controlled using acetaminophen or NSAIDs alone. Opioids work by interfering with the brain’s normal processing of pain signals. Some of the medications in this category are combination drugs that include acetaminophen or aspirin, which also has anti-inflammatory properties. Dosing must be carefully monitored because the body can develop a strong physical dependence on them over time. Side effects include drowsiness, dizziness, and nausea.
Drugs in this category include:
Pain Relief: Muscle Relaxants
These medications help relieve neck pain caused by muscle spasms and are most appropriate for short-term use. According to the U.S. Food and Drug Administration, muscle relaxants lose their effectiveness after about two weeks. Some are habit-forming and cause side effects, like drowsiness, dizziness, and confusion, which can prevent you from thinking clearly and safely driving a car or operating machinery.
Drugs in this category include:
- Soma (carisoprodol)
- Flexeril (cyclobenzaprine)
- Valium (diazepam)
- Robaxin (methocarbamol)
- Zanaflex (tizanidine)
Pain Relief: Neuropathic and Nerve-Blocking Medications
For neck pain caused by a pinched nerve or nerve disorder, relief may come from antidepressants, anticonvulsants, and nerve blockers — medications that work by interfering with the way that the brain receives or interprets pain signals or by blocking the pain signals being sent from an irritated nerve. Side effects for antidepressants and anticonvulsants include anxiety, restlessness, drowsiness, dry mouth, and weight gain; anesthetics can cause dizziness, drowsiness, and nausea.
Drugs in these categories include:
- Antidepressants such as amitriptyline (Elavil), duloxetine (Cymbalta), escitalopram (Lexapro), imipramine (Tofranil), fluoxetine (Prozac), nortriptyline (Aventyl, Pamelor), paroxetine (Paxil), sertraline (Zoloft), and venlafaxine (Effexor)
- Anticonvulsants such as gabapentin (Neurontin), levetiracetam (Keppra), pregabalin (Lyrica), phenytoin (Dilantin), and topiramate (Topamax)
- Nerve-blocking medications such as local anesthetics bupivacaine, lidocaine, and novocaine, and primary neuron blockers like over-the-counter pepper creams and the high-potency capsaicin prescription cream called Zostrix
Pain Relief: Steroids
Steroids are strong anti-inflammatory hormones used to ease inflammation pain. Steroids must be used with extreme caution because they can have troubling side effects if taken for longer than a week; they are known to promote osteoporosis, inhibit the immune system, cause fluid retention and swelling, and increase appetite and blood sugar levels.
Drugs in this category include:
- Decadron (dexamethasone)
- Medrol (methylprednisolone)
- Prednisolone and prednisone
Pain Relief: Botulinum Toxin
The FDA has also approved the use of botulinum toxin type A (Botox) and botulinum toxin type B (Myobloc) for treating neck pain caused by severe muscle spasms. Both work by partially paralyzing the involved muscles. It can take 3 to 10 days before patients begin to feel relief, but relief may last for 4 months. Side effects may include more serious paralysis of those muscles than desired and difficulty swallowing, but both are temporary.
When over-the-counter pain relief doesn’t help your neck pain, it’s important to consult your doctor to find out the underlying cause of the discomfort and, in turn, the best pain medication to treat it.
Sciatica: Management and Treatment
How is sciatica treated?
The goal of treatment is to decrease pain and increase mobility. Treatment most often includes limited rest (on a firm mattress or on the floor), physical therapy, and the use of medicine to treat pain and inflammation. A customized physical therapy exercise program might be developed.
Medicine. Pain medicines and anti-inflammatory drugs help to relieve pain and stiffness, allowing for increased mobility and exercise. There are many common over-the-counter medicines called non-steroidal anti-inflammatory drugs (NSAIDs). They include aspirin, ibuprofen (Motrin®, Advil®), and naproxen (Naprosyn®, Aleve®).
Muscle relaxants, such as cyclobenzaprine (Flexeril®), might be prescribed to relieve the discomfort associated with muscle spasms. However, these medicines might cause confusion in older people. Depending on the level of pain, prescription pain medicines might be used in the initial period of treatment.
Physical therapy. The goal of physical therapy is to find exercise movements that decrease sciatic pain by reducing pressure on the nerve. A program of exercise often includes stretching exercises to improve flexibility of tight muscles and aerobic exercise, such as walking. The therapist might also recommend exercises to strengthen the muscles of your back, abdomen, and legs.
Spinal injections. An injection of a cortisone-like anti-inflammatory medicine into the lower back might help reduce swelling and inflammation of the nerve roots, allowing for increased mobility.
Surgery. Surgery might be needed for people who do not respond to conservative treatment, who have progressing symptoms, and are experiencing severe pain.
Surgical options include:
- Microdiscectomy. This is a procedure used to remove fragments of a herniated disc.
- Laminectomy.The bone that curves around and covers the spinal cord (lamina), and the tissue that is causing pressure on the sciatic nerve are removed.
Many people believe that yoga or acupuncture can improve sciatica. Massage might help muscle spasms that often occur along with sciatica. Biofeedback is an option to help manage pain and relieve stress, which can affect your ability to cope with pain. These are referred to as alternative therapies.
What complications are associated with sciatica?
Chronic (ongoing and lasting) pain is a complication of untreated sciatica. If the “pinched nerve” is seriously injured, chronic muscle weakness, such as a “drop foot,” might occur.
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It may be interesting to know that not all pinched nerves in the neck cause pain, numbness or weakness, and many people who do suffer some pain go on to get better without treatment. For those that do experience pain, numbness, or weakness from a pinched nerve or whose pain returns, there are several nonoperative treatment options available.
It is always recommended that you begin with the least invasive options when receiving treatment for a pinched nerve in the neck, known as cervical radiculopathy. These include the use of physical therapy to help stretch and strengthen the neck muscle. Soft collars may also provide some relief as they limit motion, decreasing the pinching of the nerve that happens when you move and they also allow your neck muscles to relax.
You can often get relief from your symptoms by adding medication to your treatment for a pinched nerve in the neck. Non-steroidal anti-inflammatory drugs may help the pain caused by nerve inflammation. Over-the-counter muscle relaxers can also provide a certain degree of relief as well. For severe pain your Chicago pain management doctor may prescribe opiates, neuropathic medicines like Lyrica or stronger muscle relaxers.
Spinal decompression is another nonsurgical option that may relieve the pain from a pinched nerve in the neck. It is a form of intermittent traction that is performed in-office by a qualified doctor. You lie on a motorized table that is controlled by a computer and programmed by your doctor based on your specific needs.
It works to gently stretch the spine which takes pressure off of your spinal disks, providing pain relief. The time and frequency of treatments varies from person to person with each session lasting anywhere from 30 to 45 minutes with approximately 20 – 30 sessions spread out over several weeks.
Epidural injections may be an option for those whose pain is severe and are looking for an effective alternative to surgery. Performed in an outpatient setting, the needle is directed using fluoroscopic guidance to the site of the injury and places anti-inflammatory
medicine in the epidural space. This reduces inflammation and pain and also helps with the healing process.
Many patients note improvement immediately or within the first couple of weeks and often only one injection is required while some may need up to 3 injections spread out over 6 to 8 weeks.
In severe cases or in those whose symptoms keep returning, surgery may be recommended when nonsurgical treatments for the pinched nerve in the neck have been exhausted. This surgery involves typically removing the disc and fusing the level in a procedure called an anterior cervical discectomy and fusion. The surgery should only be performed as a last resort.
What is a Pinched Nerve?
Pinched Nerve Causes and Risk Factors
A pinched nerve is caused by excessive pressure on a nerve root. Some causes may be due to a slipped disc, bone spurs, or tendons. There are several things that can increase the risk of a pinched nerve, including:
- Repetitive movements
- Being overweight
- Participating in certain sports
- Heavy or improper lifting
- Abnormal spine structure
Though you can’t stop aging or regular wear and tear on the spine from happening, pinched nerve prevention is possible if you take measures to protect the spine, such as practicing proper lifting and good posture, and maintaining a healthy weight—all of which result in less stress on the spine.
In most cases, pinched nerve symptoms caused by a minor injury, like lifting something heavy or sleeping with your neck in an awkward position, will resolve quickly. If the pain is severe or lasts, it could indicate a more serious spine condition that could lead to permanent nerve damage and chronic pain if not treated.
Pinched Nerve Symptoms
The symptoms of a pinched nerve vary depending on the location of the affected nerve. You’ll usually feel pain in the areas that the nerve supplies sensation to. For example, pinched nerve symptoms from the neck will be felt in the shoulders, arm and hand, while a pinched nerve in the lower back causes pain and other associated pinched nerve symptoms to radiate down the leg.
The symptoms of a pinched nerve include:
- Pain that radiates outward
- Tingling or “pins and needles” sensation
- Muscle weakness
Pinched nerve symptoms often seem worse at night. Carpal tunnel syndrome, which results from pressure on the median nerve in the carpal tunnel, is especially painful at night, often waking a person from sleep.
Pinched Nerve Treatment Options
Pinched nerve treatment begins with rest and avoiding activities that put pressure on the compressed nerve. Along with rest, treatment for pinched nerve may also include a combination of the following:
- Pain medication – Nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics can relieve mild to moderate pain and inflammation. If over-the-counter (OTC) medications don’t provide sufficient relief, your doctor may prescribe a stronger pain medication.
- Heat and cold – Applying heat and cold to the affected area can help reduce pain and inflammation. Alternating between both has been found to be most beneficial.
- Muscle relaxants – Your doctor may prescribe a muscle relaxant medication to help with muscle spasms.
- Physical therapy – A physical therapist can teach you exercise to strengthen the muscles around the spine and stretches to help relieve pressure on the spine and increase flexibility. They can also advise you on proper lifting and posture techniques for pinched nerve prevention.
- Corticosteroid injections – Steroid medication, sometimes in combination with a numbing agent, can be injected into the affected area to temporarily relieve inflammation and pain.
Rest along with a combination of these nonsurgical pinched nerve treatment options can be very effective in relieving pinched nerve symptoms caused by a minor injury. In some cases, however, surgery may be recommended, such as when:
- Pinched nerve symptoms aren’t relieved with conservative treatment
- Weakness is affecting your ability to stand, walk or perform other functions
- Your pain is severe or worsening
- Your pinched nerve is the result of a spinal condition that will only improve with surgery
If any of these apply to you and you’re not experiencing the relief you need, call us today at 1.844.890.7439. Back Pain Centers of America has helped more than 30,000 people just like you find relief from pinched nerve pain and other spinal conditions. Our minimally-invasive procedures offer quick relief of symptoms without the long recovery period or risks of traditional open surgery. Give us a call to learn more. This call is simple, and it won’t cost you anything. Don’t delay. It could be the most important call you ever make.
Nonsurgical Treatments for Herniated Disc
No two people experience a herniated disc in the same way. One person may hardly notice symptoms, whereas another may need medication for serious pain. Doctors at NYU Langone can assess the type of medication you need based on your diagnosis and description of what hurts.
Nonsteroidal Anti-Inflammatory Medications
Some of the pain associated with a herniated disc may be due to inflammation in the nerves and soft tissue surrounding the affected disc. When an inflamed nerve swells, it may push up against the slipped disc. By treating the inflammation with nonsteroidal anti-inflammatory medications, swelling and the resulting pain may go away.
The most common nonsteroidal anti-inflammatory medications are ibuprofen, naproxen, and aspirin. All are available without a prescription, and your doctor can recommend how best to use them. If a herniated disc causes more serious pain that is not relieved by over-the-counter medications, doctors may prescribe a more potent anti-inflammatory.
If a disc slips from its place between vertebrae and pinches a nerve, the electrical signals that move from the nerve to nearby muscle tissue may be disrupted, leading to painful muscle spasms. Muscle relaxant medications can calm spasms and ease pain, letting you move more easily. Your doctor may prescribe these medications for a week or two. After that, pain caused by muscle spasms often goes away on its own.
Prescription Pain Relievers
If a herniated disc pinches a nerve, the pain can be severe. Over-the-counter medications may work to relieve pain, but if not, your doctor may recommend a brief course of prescription pain relievers. These medications are to be used for a week, at most; they are intended to help you feel better until a muscle relaxant or anti-inflammatory medication starts to work.
If other medications do not relieve your back or neck pain, your doctor may recommend corticosteroids taken by mouth. Steroids work to reduce inflammation in the area near the herniated disc, taking pressure off an affected nerve and relieving pain. Available only by prescription, steroids are typically taken for 7 to 10 days, at which time your doctor reassesses your symptoms before recommending additional treatment.
Using Muscles Relaxants To Treat Neck Pain
Sometimes, muscle relaxants such as Soma (carisoprodol), Flexeril (cyclobenzaprine), and Valium (diazepam) are used to treat neck pain. These are also sometimes combined with another medicine, such as in Norgesic, which combines orphenadrine with aspirin and caffeine.
Muscle relaxant medicines relax the muscles and are capable of reducing pain in people with muscle spasms. The laxative effect of these medicines is mostly the result of depression of the central nervous system. They are most helpful when the person has severe muscle spasms following the beginning of neck pain, and only recommended for initial, short-term treatment. Diazepam and carisoprodol are not recommended for treating pregnant women, older adults, or people who have depression or a history of drug or alcohol addiction.
It is vital to speak to your pharmacist about the side effects before you start imbibing muscle relaxants. Possible side effects include:
- Possible addiction or dependence
- Dry mouth
- Urinary retention
These side effects may go away after you take the medicine for a while, and if they still bother you, call the doctor. He or she can lower the dose, or change the medicine. Do not stop taking the medicine unless you have explicit instructions from the doctor. It’s best to take these medicines at bedtime, but if you do use one during waking hours, make sure to avoid driving, operating machinery, or performing sensitive activities or those which are dangerous if you get drowsy.
Follow up care is an important part of treatment, which is why you should ensure not to miss any appointments. Call your doctor if problems surface and keep a list of your medicines ready if you need to go for additional checkups.
Side Effects of Muscle Relaxers
What are Muscle Relaxers?
Muscle relaxers or muscle relaxants are medications used to treat acute muscle pain and discomfort caused by muscle spasms. Muscle spasms are involuntary contractions that cause excessive strain in muscles and are often associated with conditions such as lower back pain and neck pain.
Medications used as muscle relaxers can differ in their chemical structures and the way they work in the brain. In general, muscle relaxers act as central nervous system depressants and cause a sedative effect or prevent your nerves from sending pain signals to your brain. The onset of action is rapid and effects typically last from 4-6 hours.
Some of the common side effects of muscle relaxers include:
- Dry mouth
- Decreased blood pressure
The most commonly prescribed muscle relaxers are carisoprodol (Soma) and cyclobenzaprine (Flexeril). According to data from IMS Health, there were 4.2 million prescriptions of Soma and 28.4 million prescriptions of Flexeril dispensed in the United States in 2017.1-2
Muscle Relaxer Abuse
Muscle relaxers have a potential for abuse and addiction. Prolonged use can lead to increased tolerance and physical dependence, especially with Soma.3 For this reason, muscle relaxers are intended as a short-term treatment not to be prescribed for more than 2-3 weeks.
Unfortunately, many individuals take muscle relaxers alone or in combination with other illicit drugs for nonmedical reasons, such as to produce or enhance feelings of euphoria and dissociation. According to the Drug Enforcement Administration, Soma is one of the most commonly diverted drugs in the United States.2 Evidence also indicates prevalent misuse of Flexeril. In 2010 there were over 12,000 emergency room visits associated with Flexeril, and in 2016 over 10,000 calls to the Poison Control Centers had involved Flexeril.1
Muscle relaxer abuse can lead to serious dangers such as an increased risk of overdose, which can result in:
- respiratory depression
- cardiac arrest
Alcohol and Muscle Relaxers
Like muscle relaxers, alcohol also depresses the central nervous system. When alcohol is consumed with muscle relaxers the side effects are exacerbated. This can be very dangerous, leading to symptoms like:
- Blurred vision
- Urine retention
- Extreme dizziness
- Extreme drowsiness
- Low blood pressure
- Memory problems
- Liver damage
- Increased risk of overdose
It is recommended to not drive or operate heavy machinery when under the influence of muscle relaxers. It is especially important to avoid drinking, as combining muscle relaxers with alcohol greatly increases your risk of an accident.
Withdrawal and Treatment
Regular use of muscle relaxers causes the brain to become used to its effects. If you attempt to suddenly stop using muscle relaxers you may experience withdrawal symptoms. Depending on the specific drug and how long you have been using it, there are various treatment options available to help you overcome your addiction.
For many people, Flexeril withdrawal causes mild symptoms such as nausea, headache, drowsiness, malaise, and discomfort. Symptoms tend to peak about 2-4 days after you last took the Flexeril, although in some people withdrawal symptoms may last for up to 1-2 weeks. For many people Flexeril detox can be done at home. However, if Flexeril addiction is accompanied by alcohol or opioid abuse the withdrawal symptoms from these other substances can be severe. In these situations, it may be best to undergo professional medical detox.
Soma withdrawal is usually more severe and can include symptoms like hallucinations and seizures. For your safety and comfort, it is often best to find an inpatient treatment program that includes a detox program to manage withdrawal symptoms. After detox patients can transition into the actual treatment phase of the program. Some people may not require a supervised detox program and will be able to undergo treatment on an outpatient basis.
Most inpatient and outpatient rehab programs include cognitive behavioral therapy that will help you learn the coping skills needed for long-term recovery.