Which Muscle Relaxers Are Best for Neck and Back Pain?
Key takeaways:
Treatment for muscular neck and back pain includes physical therapy, home exercise, and medications.
Muscle relaxers are another possible path to relief. These medications may help relieve pain due to muscle strain or tightness in the short term. But there isn’t much strong evidence to support their use.
Speak with a healthcare professional about the possible side effects of these medications and whether they’re right for you.
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Table of contents
Stiffness and soreness in your neck and back can be difficult to deal with, especially when sleeping. Maybe you have a new injury, or you’ve aggravated an old one. Either way, if you feel this kind of pain at night, you may not sleep well. And then you may have more pain when you wake up. In some cases, muscle relaxers can help relieve this pain and get you through these tough days.
With so many muscle relaxers to choose from, you may be wondering which one works best. Let’s take a closer look at a list of commonly used muscle relaxers for neck and back pain, as well as their potential side effects.
What do muscle relaxers do?
Muscle relaxers do exactly what their name says: relax muscles. Most episodes of sudden, acute low-back pain are due to muscle strain. Reducing muscle tightness may improve new neck and back pain, especially when used at night.
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Muscle relaxers can work in different ways. They may act on your muscles, nerves, or central nervous system.
There are three main categories: benzodiazepines, antispasticity medications, and non-benzodiazepine muscle relaxers. A recent review of studies found that benzodiazepines and spasticity medications aren’t effective for short-term relief from back pain. The others can help with pain initially but aren’t effective after 2 weeks.
It’s important to note that muscle relaxers shouldn’t be taken for more than a couple of weeks. Studies show they don’t work for chronic back pain.
Let’s look at popular muscle relaxants, including how well they work and their side effects.
1. Cyclobenzaprine
Cyclobenzaprine is a reasonable first choice because it’s a cheap generic medication. It’s the most commonly prescribed muscle relaxer. But it has more potential for side effects, like drowsiness. This limits how you can use it during the day. If this is an ongoing concern, it may be a good idea to consider a non-sedating option.
You may want to break your tablet in half to decrease this effect. Interestingly, one study found that a lower dose of cyclobenzaprine (15 mg) worked just as well as a higher dose (30 mg). Another option is to consider the extended-release formulation instead of the immediate-release formulation.
Cyclobenzaprine may also cause dry mouth, especially in older adults.
2. Methocarbamol
Methocarbamol (Robaxin) is a well-studied medication that treats back pain. Compared to other options, it’s inexpensive and less likely to make you sleepy (sedated).
Muscle relaxer side effects: Find out more about what you can expect when taking muscle relaxers, including the most common side effects.
Alcohol and muscle relaxers don’t mix. Learn why this can be a dangerous combination that should be avoided.
Common muscle relaxer dosing: Wondering if you’re on a low dose? This guide discusses typical cyclobenzaprine doses for common conditions.
Methocarbamol is generally a well-tolerated option for people who have new neck and back pain. But it may be less effective. In one study, almost 1 in 5 people taking it stopped because it wasn’t helping their pain go away.
3. Carisoprodol
Carisoprodol (Soma) is classified as a medication that has the potential for misuse. For this reason, you shouldn’t use it if you have a history of substance use disorder. If prescribed, you should only use it for short periods of 2 to 3 weeks.
Carisoprodol may also cause drowsiness and dizziness. It’s not a good choice for people over age 65. Because of the potential side effects, some experts believe that carisoprodol should be phased out as a muscle relaxant in favor of much better options. It’s no longer available in several European countries and the U.K.
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4. Metaxalone
Metaxalone (Skelaxin) is a muscle relaxer that has the fewest reported side effects. It’s also the least likely of the muscle relaxants to make you sleepy. It works as well as cyclobenzaprine and carisoprodol, with fewer side effects and less sedation.
Metaxalone is a generic medication, but it still tends to cost more than most other muscle relaxers. Insurance companies often don’t cover it because there are cheaper alternatives.
5. Tizanidine and baclofen
Tizanidine (Zanaflex) and Baclofen (Gablofen, Lioresal) treat spasticity in people with multiple sclerosis, spinal cord injury, or cerebral palsy. Spasticity is where the muscles contract continuously and resist lengthening. This leads to stiffness and difficulty with movement.
These medications are sometimes prescribed for muscle spasms related to back pain, but they aren’t first-choice options. They are only FDA-approved to treat spasticity. And they’re more likely than the other categories to cause side effects when prescribed for acute back pain.
6. Oxazepam and diazepam
Benzodiazepine medications, like oxazepam (Serax, Zaxopam) and diazepam (Valium), are anti-anxiety medications. They’re sometimes prescribed as muscle relaxants. But these really aren’t recommended because they don’t work well, are sedating, and can be habit-forming.
Plus, the FDA hasn’t approved benzodiazepines for neck or back pain. It’s a good idea to avoid these medications for neck and back muscle pain, since there are much better options.
7. Chlorzoxazone
Chlorzoxazone (Lorzone) isn’t well studied for new low-back and neck pain in adults. And it wasn’t found to be effective for pain after spine surgery. Chlorzoxazone has also been reported as a rare cause of acute liver toxicity. A healthcare professional may consider prescribing this medication once you’ve exhausted all other options.
What are some risks and side effects of muscle relaxers?
Muscle relaxers can cause some side effects and sometimes interact with other medications and substances. That’s why it’s important to let your prescriber know about your medical history and which medications and supplements you’re taking.
Common medications that can interact with muscle relaxers include sedatives, antidepressants, and antihistamines.
Sedatives
Many muscle relaxers have a sedative effect, meaning they slow brain activity. If you’re taking other medications that also affect your brain, you could have severe side effects.
Sedative medications that may also interact with muscle relaxers include:
Sleep medications, like Zolpidem (Ambien)
Gabapentin (Neurontin)
Pregabalin (Lyrica)
Opioid pain medications (oxycodone, hydrocodone)
Antidepressants
Some muscle relaxers can also affect serotonin (a hormone that affects mood) levels in the brain. If you’re already taking medications for your mood, muscle relaxers could cause serotonin levels to become too high.
Some antidepressants that can cause an interaction with muscle relaxers are:
Amitriptyline (Elavil)
Venlafaxine (Effexor)
SSRIs, like sertraline (Zoloft) and fluoxetine (Prozac)
Selegiline (Zelapar)
Anticholinergics
Anticholinergic medications are commonly used to treat lots of conditions, including overactive bladder, digestive conditions, and movement disorders, like Parkinson’s disease.
These medications can have side effects, like trouble urinating, constipation, or dry mouth. Adding a muscle relaxer to these medications can make these side effects more severe.
Anticholinergics that may interact with muscle relaxers include:
Diphenhydramine (Benadryl)
Hyoscyamine (Levsin)
Benztropine (Cogentin)
Scopolamine (Transderm Scop)
Frequently asked questions
No, you need a prescription for muscle relaxers. Over-the-counter (OTC) pain relievers, such as acetaminophen (Tylenol) and ibuprofen (Advil, Motrin), work better for neck and back pain than muscle relaxants alone. Some people may benefit from taking an OTC pain reliever and a muscle relaxer together, especially at night.
Some muscle relaxers, like carisoprodol, can be addictive. These are often not good first-choice treatment options for back and neck pain. The evidence is mixed regarding how well they work since most people improve over time regardless of the treatment used. Discuss your options with your prescriber if you’re concerned about your treatment becoming habit-forming.
Yes, muscle relaxers can make you sleepy. In fact, sedation is one of the most common side effects reported. Dizziness and drowsiness are also commonly reported. That’s why this type of medication usually has a warning on the label that instructs you to avoid certain things while taking them, such as driving, caring for children, and operating heavy machinery.
The bottom line
Having neck and/or back pain can be frustrating. Some people may find short-term relief with prescription muscle relaxers. But the evidence to support their use isn’t strong, and they aren’t good for long-term use. Because muscle relaxers cause drowsiness, it’s important that you don’t drive while taking them. If you continue to have neck or back pain with no relief, reach out to a healthcare professional to discuss other treatment options.
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References
Abril, L., et al. (2022). The relative efficacy of seven skeletal muscle relaxants. An analysis of data from randomized studies. The Journal of Emergency Medicine.
Borenstein, D. G., et al. (2003). Efficacy of a low-dose regimen of cyclobenzaprine hydrochloride in acute skeletal muscle spasm: Results of two placebo-controlled trials. Clinical Therapeutics.
Cashin, A. G., et al. (2021). Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: Systematic review and meta-analysis. BMJ.
Emrich, O. M. D., et al. (2015). Methocarbamol in acute low back pain. A randomized double-blind controlled study. MMW Fortschritte der Medizin.
Li, Y., et al. (2021). Utilization patterns of skeletal muscle relaxants among commercially insured adults in the United States from 2006 to 2018. Pain Medicine.
Nielsen, R. V., et al. (2016). The effect of chlorzoxazone on acute pain after spine surgery. A randomized, blinded trial. Acta Anaesthesiologica Scandinavica.
Oldfield, B. J., et al. (2024). Long-term use of muscle relaxant medications for chronic pains: A systematic review. JAMA.
Pilitsis, J. G. (2024). Spasticity. American Association of Neurological Surgeons.
Qaseem, A., et al. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine.
See, S., et al. (2008). Choosing a skeletal muscle relaxant. American Family Physician.
