Skeletal muscle relaxants are drugs that were approved years ago for short-term treatment of muscle spasms and back pain and are used today, without good evidence, to treat chronic pain and other conditions.
Recommendations generally limit the use of these drugs to a maximum of three weeks, since they have not been shown to work for muscle spasms beyond that duration, and they can cause serious side effects including falls, fractures, vehicle crashes, abuse, dependence, and overdose.
Due to these risks, muscle relaxants should be avoided altogether in elderly patients, according to guidelines from the American Geriatrics Society.
In a recent study at the University of Pennsylvania, researchers found office visits for ongoing prescribing of skeletal muscle relaxant drugs tripled from 2005 to 2016.
Moreover, in 2016, nearly 70% of patients prescribed muscle relaxants were simultaneously prescribed an opioid—a combination that has the potential to cause dangerous interactions.
The researchers also found that muscle relaxants were prescribed disproportionately to older adults during this time period, despite national guidelines warning that this class of drugs should almost always be avoided in patients who are 65 and older.
The study is published in JAMA Network Open. One author is Charles E. Leonard, PharmD, MSCE, an assistant professor of Epidemiology.
In the study, the team hypothesized that the growing opioid epidemic may have led clinicians to prescribe muscle relaxants as an alternative to opioids for long-term pain management.
They analyzed publicly-available 2005–2016 data from the National Ambulatory Medical Care Survey.
From 2005 to 2016, the number of office visits resulting in new muscle relaxant prescriptions remained stable at approximately 6 million per year, while office visits for continued muscle relaxant drug therapy tripled—from 8.5 million in 2005 to 24.7 million in 2016.
Worryingly, older adults accounted for 22.2% of all muscle relaxant visits in 2016, even though this group accounted for just 14.5% of the U.S. population.
Also of concern, in 2016, 67% of the continued muscle relaxant visits also recorded therapy with an opioid.
The U.S. Food and Drug Administration warns against the use of co-prescribing of these medications, because of the risk of serious side effects, including slowed or difficult breathing, and death.
The team say for older adults, the message should be to avoid using muscle relaxants, especially when researchers consider the side effects and increased risk of falls and fractures, and to find alternatives for pain management
In addition to potential adverse effects, muscle relaxants may not be any more effective in managing pain than medications like Tylenol or Advil.
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