Multifactorial Dependence of Muscle Relaxant Efficacy in Lower Back Pain

We read with interest the article by Abril et al., who reported a study on the efficacy of seven skeletal muscle relaxants (SMRs) for lower back pain (LBP) ( 1 Abril L Zamora C Cordero M Williams AR Friedman BW The relative efficacy of seven skeletal muscle relaxants. An analysis of data from randomized studies. J Emerg Med. 2022; 62: 455-461 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar ). Four randomized controlled trials were retrospectively pooled and analyzed together for efficacy and adverse-effect profiles of baclofen, metaxalone, tizanidine, diazepam, orphenadrine, methocarbamol, and cyclobenzaprine compared with placebo and whether efficacy was related to age, sex, or baseline LBP-related functional impairment, as assessed by the Roland-Morris Disability Questionnaire (RMDQ) ( 1 Abril L Zamora C Cordero M Williams AR Friedman BW The relative efficacy of seven skeletal muscle relaxants. An analysis of data from randomized studies. J Emerg Med. 2022; 62: 455-461 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar ). It was concluded that SMRs, in addition to nonsteroidal anti-inflammatory drugs, did not improve outcomes and that age, gender, and baseline RMDQ had no effect on outcomes ( 1 Abril L Zamora C Cordero M Williams AR Friedman BW The relative efficacy of seven skeletal muscle relaxants. An analysis of data from randomized studies. J Emerg Med. 2022; 62: 455-461 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar ). The study is excellent but has limitations that should be discussed. The Relative Efficacy of Seven Skeletal Muscle Relaxants. An Analysis of Data From Randomized StudiesJournal of Emergency MedicineVol. 62Issue 4PreviewLow back pain (LBP) causes 2.6 million visits to U.S. emergency departments (EDs) annually. These patients are often treated with skeletal muscle relaxants (SMRs). Full-Text PDF