Efficacy and tolerability of muscle relaxants for low back pain: Systematic review and meta-analysis

Abdel Shaheed, C; Maher, CG; Williams, KA; McLachlan, AJ

Efficacy and tolerability of muscle relaxants for low back pain: Systematic review and meta-analysis

Abdel Shaheed, C Maher, CG Williams, KA

McLachlan, AJ

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Publication Type:: Journal Article
Citation:: European Journal of Pain (United Kingdom), 2017, 21 (2), pp. 228 - 237
Issue Date:: 2017-02-01

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Field	Value	Language
dc.contributor.author	Abdel Shaheed, C	en_US
dc.contributor.author	Maher, CG	en_US
dc.contributor.author	Williams, KA https://orcid.org/0000-0002-5094-243X	en_US
dc.contributor.author	McLachlan, AJ	en_US
dc.date.available	2016-05-02	en_US
dc.date.issued	2017-02-01	en_US
dc.identifier.citation	European Journal of Pain (United Kingdom), 2017, 21 (2), pp. 228 - 237	en_US
dc.identifier.issn	1090-3801	en_US
dc.identifier.uri	http://hdl.handle.net/10453/124452
dc.description.abstract	© 2016 European Pain Federation - EFIC ® Muscle relaxants are commonly prescribed for low back pain (LBP); however, there is limited evidence of their clinical efficacy and tolerability. This review evaluated the efficacy and tolerability of muscle relaxants in people with LBP. We searched online databases including Medline, EMBASE, CENTRAL and PsycINFO (inception to end October 2015) and performed citation tracking for eligible randomized controlled trials (RCTs). Two authors independently extracted data and assessed risk of bias of randomized controlled trials of muscle relaxants. Pain outcomes were converted to a common 0–100 scale. Data were pooled using a random effects model with strength of evidence assessed using GRADE. Fifteen trials (3362 participants) were evaluated in this review. A total of five trials (496 participants) provide high quality evidence that muscle relaxants provide clinically significant pain relief in the short term for acute LBP; MD −21.3, [−29.0, −13.5]. There was no information on long-term outcomes. The median adverse event rate in clinical trials for muscle relaxants was similar to placebo 14.1% IQR (7.0–28.7%) and 16.0% (4.1–31.2%); p = 0.5, respectively. There is no evidence for the efficacy of benzodiazepines in LBP. For people with acute LBP, muscle relaxants provide clinically significant short-term pain relief. For chronic LBP, the efficacy of muscle relaxants is largely unknown. There was no eligible RCT evidence to support the efficacy of benzodiazepines in LBP. Prolonged use of these medicines in LBP cannot be guided by trial evidence. What does this review add?: Muscle relaxants provide clinically significant pain relief for acute low back pain. Caution must be taken with the interpretation of the findings as the evidence comes from specific muscle relaxant medicines.	en_US
dc.relation.ispartof	European Journal of Pain (United Kingdom)	en_US
dc.relation.isbasedon	10.1002/ejp.907	en_US
dc.subject.classification	Anesthesiology	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Low Back Pain	en_US
dc.subject.mesh	Muscle Relaxants, Central	en_US
dc.subject.mesh	Treatment Outcome	en_US
dc.subject.mesh	Pain Management	en_US
dc.title	Efficacy and tolerability of muscle relaxants for low back pain: Systematic review and meta-analysis	en_US
dc.type	Journal Article
utslib.citation.volume	2	en_US
utslib.citation.volume	21	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1109 Neurosciences	en_US
utslib.for	1115 Pharmacology and Pharmaceutical Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Graduate School of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
utslib.copyright.status	closed_access
pubs.issue	2	en_US
pubs.publication-status	Published	en_US
pubs.volume	21	en_US

Abstract:

© 2016 European Pain Federation - EFIC ® Muscle relaxants are commonly prescribed for low back pain (LBP); however, there is limited evidence of their clinical efficacy and tolerability. This review evaluated the efficacy and tolerability of muscle relaxants in people with LBP. We searched online databases including Medline, EMBASE, CENTRAL and PsycINFO (inception to end October 2015) and performed citation tracking for eligible randomized controlled trials (RCTs). Two authors independently extracted data and assessed risk of bias of randomized controlled trials of muscle relaxants. Pain outcomes were converted to a common 0–100 scale. Data were pooled using a random effects model with strength of evidence assessed using GRADE. Fifteen trials (3362 participants) were evaluated in this review. A total of five trials (496 participants) provide high quality evidence that muscle relaxants provide clinically significant pain relief in the short term for acute LBP; MD −21.3, [−29.0, −13.5]. There was no information on long-term outcomes. The median adverse event rate in clinical trials for muscle relaxants was similar to placebo 14.1% IQR (7.0–28.7%) and 16.0% (4.1–31.2%); p = 0.5, respectively. There is no evidence for the efficacy of benzodiazepines in LBP. For people with acute LBP, muscle relaxants provide clinically significant short-term pain relief. For chronic LBP, the efficacy of muscle relaxants is largely unknown. There was no eligible RCT evidence to support the efficacy of benzodiazepines in LBP. Prolonged use of these medicines in LBP cannot be guided by trial evidence. What does this review add?: Muscle relaxants provide clinically significant pain relief for acute low back pain. Caution must be taken with the interpretation of the findings as the evidence comes from specific muscle relaxant medicines.

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http://hdl.handle.net/10453/124452