Muscle Relaxants

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simplytranquil
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Hi there!

This is my first post on pharmer,I am glad I found this site. My question is regarding musculoskeletal relaxants. I have not been diagnosed with any pain disorder, yet suffer from definitely muscle, if not neuropathic pain as well. My GP seems deadset on cyclobenzaprine (Flexeril) for any muscle tension/pain. I personally despise the stuff. Mostly because it amplifies my anxiety, ten fold, and I cannot sleep (similar to my reactions with DPH). Thus, I have been given methocarbamol, with no luck, and Skelaxin (800mg tabs) in the past, with 'some' luck. I have also been prescribed gabapentin, and currently can take 200mg daily. This could be easily increased, though my GI tract seems to be very sensitive, possibly to the capsule of gabapentin itself. So I am looking elsewhere to assist my clonazepam (3mg daily). As the gabapentin seems to work but only once in a blue moon.

Whence my question is, what are folks thoughts/experiences with baclofen, Lyrica, or carisoprodol? I have heard that if one has any sort of tolerance to benzos (I am going on year three now, of daily dosing) that I am likely not to feel much with Soma. Lyrica, I hear has many positives but also plenty of negatives. And baclofen seems underreported, from my perspective.

Thanks in advance for any insight or thoughts. It may be important to add that I am past the SSRIs, trazodone, mirtazapine, DPH, DXM, and any form of bupropion (Wellbutrin or Aplenzin). Apparently, I am 'more sensitive' to drug side effects. Anyway, there's some background. I have also been tested for Adult ADD with negative results. I have been diagnose clinically with panic disorder, GAD, social anxiety, insomnia (hypersomnia) and MDD in the past. I am currently also taking Lunesta (2mg) for major sleep issues. I am happy to answer other questions to help you understand my situation further.

S

BrokenDownNurse
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muscle relaxer

Welcome to the forum!  I am pretty new here as well.  Here you'll find lots of people who can provide answers and information in a very empathetic way. 

Where do you have the muscle spasms? When and what makes it worse? 

I take Flexeril about an hour before I try to go to sleep.  Lunesta 3mg helps me go to sleep.

Can't take Skelaxin as it makes me very jittery and I actually twitch. 

I don't have experience with any other muscle relaxers.

Good luck to you and please keep us posted!

goat
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re:

 that is a very low dose of gabapentin.. dosage for nerve pain can vary from 900 to 1800 mg or even higher.

I was taking well over 2000 mg and did have relief.   Ask your dr

celticgreenman
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Baclofen

simplytranquil,

Baclofen is usually prescribed for management of spasticity seen is disorders such as multiple sclerosis or spinal cord injuries. Its actually mechanism of action is totally not understood, it is believed to work on the nerves within the central nervous system and at the spinal cord level. It has been used "off label" for spastic bladder, hiccups, and alcohol withdrawal symptoms. It is usually not recommended for intermittent spasms of the skeletal muscles.

Baclofen usage must be managed closely by the patient's physician. It has a low tolerance for overdose. The maximum daily amount is 80 mg total. The amount needed to alleviate a patient’s spasticity varies greatly, which is why it is recommended that the lowest dose be prescribed at first.  Then, it should be titrated very slowly.  But, if the maximum dose is reached and the patient does not have significant relief with the medicine, it should be slowly titrated back down and discontinued.  Since it is eliminated by the kidneys, any patient with renal disease should not be prescribed Baclofen. Also, blood glucose levels have to be watched carefully in diabetic patients, as it has been known to "bump" the blood glucose levels.

Thus, it is usually not recommended for muscle spasms associated with musculoskeletal or arthritic conditions. But, you can discuss the subject with your physician.

 

The "muscle relaxers" actually do not have any effects on skeletal muscle itself. Again, as with many medications, their actual mechanism of action is not totally understood. The muscle relaxers are usually prescribed for their sedating properties. In many cases, if patients can get a good night's sleep, their muscle tightness/spasm will decrease significantly.

 

Usually, in orthopedics, if a patient actually needs muscle spasms treated, such as in the post injury/surgery period, one of the benzodiazepines (usually valium) is prescribed for a short course. This is a common treatment used by spine surgeons in the acute post-op period.

 

So, you should discuss all of your concerns with your physician. Good luck, hopefully the two of you can develop a treatment plan to take care of the majority of your problems. Welcome to Pharmer.

cgm

 

simplytranquil
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still confused

Reading through all of this, I can say this much...

thank you celticgreenman, that clears up nearly every question I had regarding baclofen.

as for my gabapentin, I know that it is a low dose compared to the max potential dose. But I don't understand considering the decline in bioavailability as dose is increased, how does it remain effective? Is it that it requires weeks of exposure in the body, and takes time to take "full effect" (similar to A/Ds, buspirone, bupropion, etc)?

Also what of Lyrica for anxiety in the US? I know the FDA has only approved it for fibromyalgia, but what about a switch from gabapentin (a less effective drug) to Lyrica? Anyone with any experience/thoughts on this particular idea?

S

sandi123
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I have taken Lyrica, for

I have taken Lyrica, for neuropathic pain, not for muscle spasms per se, but for those have taken both baclofen and zanaflex...I use a combination of both of the muscle relaxers for treatment of the spasticity and muscle spasms from my spinal cord injury and Lyrica I still use to treat my neuropathic burning, stinging pain...Lyrica can be a bit of a difficult adjustment for some but the good news is that if you can get past the first week on it, it is usually tolerated well as the side effects stabilize considerably after that...the biggest issue that I had with it was weight gain, but watching my diet helped reduce that too over time. The dosage needs to be titrated , just as many other drug dosages do, and for neuropathic pain, the usual daily dose is around 300 mg in divided doses. Before stopping it , it needs to be titrated down, just as it does when increasing the dose. It comes in doses from 25, to 200 mg so adjusting the doses by small increments is easily done.

The zanaflex needs to be gotten accustomed to as well since drowsiness is the biggest side effect but it works well as a muscle relaxer when others have failed...

I hope this helps you out,

Sandi

simplytranquil
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Interesting input

Thank you Sandi, for your commentary on your experiences with Lyrica. It does help me a bit. Though, I am still wondering if anyone out there has been prescribed Lyrica for anxiety-related diagnoses, psychiatrically, in the states? And what about Lyrica v gabapentin? Is it truly the case that the former is notably stronger than the latter? I know the bioavailability of the former is indeed high, and consistently high, something like 98%, compared to gabapentin, which has an absurd dose-to-availability pattern.

Thanks,

tranquil