Naproxen With Cyclobenzaprine, Oxycodone Acetaminophen, or Placebo for Treating Acute Low Back Pain: A Randomized Clinical Trial Pain Medicine JAMA

It is important to note that only 63% of the patients took the naproxen as prescribed. Additionally, only 62% of the patients took the study medication at least once per day, with 8% of the patients taking the medication only one time and 16% of the patients never taking the medication at all. Considering that 24% of the patients took the medication once or never, this may have affected the internal validity by blunting the effect difference between study groups. Therefore, it is possible that, if the medications were taken as prescribed, a difference may have been noted that was not identified in the study. However, this also increases the external validity, as patients are not always compliant with medications, and although having frequent reminders and phone calls to take medications may increase patient compliance, this approach is unrealistic in common practice.

For temporary relief, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute. However, if your mouth continues to feel dry for more than 2 weeks, check with your medical doctor or dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections. The amount of medicine that you take depends on the strength of the medicine.

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Some mixtures of medications can lead to serious and even fatal consequences. To view an interaction report containing 4 (or more) medications, please sign in or create an account. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Pain Management: Musculoskeletal Pain

Talk to your doctor or pharmacist if you have any questions or concerns. Muscle relaxants are frequently used as an adjunct to other medications (mostly NSAIDs) in patients with myofascial pain. Elderly patients seem to tolerate cyclobenzaprine less and may develop hallucinations as well as significant anticholinergic side effects, such as sedation. The use of significant lower dosing schedules in elderly patients may be prudent. Cyclobenzaprine is structurally similar to tricyclic antidepressants (TCAs) and has similar anticholinergic side effects such as sedation, dizziness, tachycardia, arrhythmias and may worsen heart failure, cardiac conduction abnormalities, and benign prostatic hyperplasia [29r]. Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction.

Although we cannot exclude the possibility of a modest benefit of the opioid combination in a select subgroup of patients, our data do not support providing oxycodone/acetaminophen in addition to naproxen for all ED patients with acute LBP. More than 75% of participants randomized to receive naproxen used it daily and nearly two-thirds used it twice daily (Table 3). Use of additional health care resources was infrequent in the 3 study groups. Most participants did not visit their primary care clinician or a complementary/alternative medicine practitioner prior to the 1-week follow-up (Table 3).

  • The results suggest that cyclobenzaprine is superior to both placebo and clonazepam when added to self-care and education for the management of jaw pain upon awakening.
  • It blocks the pathways of neurotransmitters that signal pain and diminishes the sensations of pain.
  • This medicine will add to the effects of alcohol and other CNS depressants (medicines that slow down the nervous system, possibly causing drowsiness).
  • Do not increase your dose or use this drug more often or for longer than prescribed.
  • Skeletal muscle relaxants may also be used as an alternative to NSAIDs in patients who are at risk of gastrointestinal or renal complications.

Dogs can take muscle relaxers such as Flexeril for pain relief. Veterinarians suggest short-term treatments with Flexeril for dogs and cats with acute muscle spasms. However, the dosage strength differs for humans and dogs, and dogs are at risk for addiction. Cyclobenzaprine (Flexeril) is structurally similar to TCAs and, as such, demonstrates significant anticholinergic does flexeril reduce inflammation side effects. Additionally, if musculoskeletal doses are exceeded, cyclobenzaprine exhibits a side-effect profile similar to that of TCAs, including lethargy and agitation, although it usually does not appear to produce significant dysrhythmias beyond sinus tachycardia. It is generally used for musculoskeletal conditions, including fibromyalgia and low back pain.

Cyclobenzaprine and naproxen versus naproxen alone in the treatment of acute low back pain and muscle spasm

Ask your healthcare professional how you should dispose of any medicine you do not use. The dose of this medicine will be different for different patients. The following information includes only the average doses of this medicine.

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It relaxes only the muscles and not the actual causative nerves behind the pain. For best results, doctors recommend combining the use of Flexeril with rest and physical therapy. Baclofen is one of the most powerful centrally acting muscle relaxants. It is usually indicated in patients with spasticity such as cerebral palsy or multiple sclerosis. In children 2 to 7 years old, the dose is 10 to 15 mg/day, divided in two to three doses. The dose can be escalated every 3 days by 5 mg to a maximum dose of 40 mg/day.

However, we chose this study design because it more closely reflects the reality of clinical practice. Quiz Ref IDPatients were excluded for radicular pain, which we defined as pain radiating below the gluteal folds, direct trauma to the back within the previous month, pain duration for more than 2 weeks, or recent history of greater than 1 LBP episode per month. We also excluded patients who were pregnant or lactating, unavailable for follow-up, with allergy or contraindication to the investigational medications, or had chronic opioid use currently or in the past.

At 1-week follow-up, regardless of study group, more than 50% of patients still required medication for LBP, and as shown in Table 2, many patients reported moderate or severe, and frequent pain. Despite these generally poor outcomes, more than two-thirds of patients reported that they would want to receive the same medications during a subsequent ED visit for acute LBP. The drug Cyclobenzaprine, sold under the brand Flexeril, is structurally very similar to a class of Antidepressants called Tricyclic Antidepressants. Flexeril is commonly prescribed to induce pain relief from muscle spasms and improve motor skills, sleep, and energy levels by generating pain relief. These feelings may potentially be a cause for misuse of Flexeril and lead to addictive effects. Although all skeletal muscle relaxants should be used with caution in older patients, diazepam especially should be avoided in older patients or in patients with significant cognitive or hepatic impairment.