Dr. Ed Libich     Chiropractor     (660) 429-1900

About Muscle Relaxers

     Pain, stiffness, and muscle spasms can be the result of sprains, strains and other muscle injuries, for example a lumbar strain can result in disabling low back pain. Many doctors prescribe muscle relaxants, which do not heal the injuries, but they do relax muscles and help ease the discomfort and stop muscle spasms. Sometimes fibromyalgia, aka, chronic fatigue syndrome, is treated with the muscle relaxant cyclobenzaprine (Flexeril) is also sometimes used to treat fibromyalgia. Flexeril is often prescribed for the relief of muscle spasms.

Available only with a physician's prescription in the United States, muscle relaxants work by acting on the central nervous systemand is in a class drugs call spasmolytics. Examples of muscle relaxants are carisoprodol (Soma), chlorzoxazone (Parafon Forte DSC),cyclobenzaprine (Flexeril), and methocarbamol (Robaxin). Most come only in tablet form. However, methocarbamol (Robaxin) is available in both tablet and injectable forms.

These drugs may make the injury feel so much better that one is tempted to go back to normal activity. But doing too much too soon can actually make the injury worse.

Sometimes patients will be given muscle relaxers for tension headaches. Muscle relaxants work quite well for relieving muscle pain due to injuries, but are not effective for other types of pain. Some people feel drowsy, dizzy, confused, lightheaded, or less alert when using muscle relaxants. They may also cause blurred vision, clumsiness, or unsteadiness.

Because muscle relaxants work on the central nervous system,
they may add to the effects of alcohol and other drugs that slow down the central nervous system. They may also add to the effects of anesthetics, including those used for dental procedures. For this reason, anyone who takes these drugs should not drive, operate machinery, or do anything else that might be dangerous until they have found out how the drugs affects them.

     People with certain medical conditions
or who are taking certain other medicines can have problems if they take muscle relaxants. Diabetes should be aware that the metaxalone (Skelaxin) may cause false test results on one type of test for sugar in the urine. People with epilepsy should be cautioned that taking the muscle relaxant methocarbamol may increase the likelihood of seizures.

Anyone who has allergies, who is breastfeeding, has kidney disease, has suffered a recent heart attack or irregular heartbeat, has an overactive thyroid gland, hepatitis or liver disease, is a current or former drug or alcohol abuser, has glaucoma, or has problems with urination should discuss their condition with their doctor before taking muscle relaxants.

Auto-injury patients suffering from whiplash resulting in
neck pain and stiffness commonly receive muscle relaxants.

The most common side effects or muscle relaxants are vision changes, such as double vision or blurred vision, dizziness, lightheadedness, drowsiness, and dry mouth. These problems usually go away as the body adjusts to the drug and do not require medical treatment. Methocarbamol and chlorzoxazone may cause harmless color changes in urine The urine will return to its normal color when the patient stops taking the medicine.

Less common side effects, such as stomach cramps or pain, nausea and vomiting, constipation, diarrhea, hiccups, clumsiness or unsteadiness, confusion, nervousness, restlessness, irritability, flushed or red face, headache, heartburn, weakness, trembling, and sleep problems also may occur.

More serious side effects are not common, but may occur. Anyone who experiences breathing problems, facial swelling, fainting, unusually fast or unusually slow heartbeat, fever, tightness in the chest, rash, itching, hives, burning, stinging, red, or bloodshot eyes, or unusual thoughts or dreams after taking muscle relaxants should seek medical help promptly.

The muscle relaxant chlorzoxazone (Parafon Forte DSC)
has caused serious, life-threatening liver problems in some people. The reaction is rare, but anyone taking the drug should stop taking it and notify his or her physician immediately if any of these symptoms occur: fever, rash, loss of appetite, nausea, vomiting, fatigue, pain in the upper right part of the abdomen, dark urine, or yellow skin or eyes.

Muscle relaxants may interact with some other medicines.
When this happens, the effects of one or both of the drugs may change or the risk of side effects may be greater. Anyone who plans to take muscle relaxants should let the physician know all other medicines, including over-the-counter or nonprescription medicines, that he or she is taking.

Alternatives to Flexeril (Cyclobenzaprine hydrochloride) a Muscle Relaxer.

  
Problems With Flexeril:

      In his book Worst Pills, Best Pills, written in collaboration with the AARP, Dr. Sidney Wolfe advises against the use of cyclobenzaprine. He states, " Cyclobenzaprine has not been shown to be any more effective than painkillers or anti-inflammatory drugs such as aspirin for relieving the pain of local muscle spasm." He further advises that Flexeril is structurally similar to tricyclic antidepressants and may cause some of the same dangerous side effects, particularly in older patients. It is also addictive.




     The PDR lists more than 65 adverse side effects for Flexeril, including dizziness, abnormal heartbeat, aggressive behavior, agitation, confusion, convulsions, hallucinations, headache, hepatitis, muscle twitching and severe allergic reactions.

      Localized muscle spasm is predominantly caused by spinal cord reflexes resulting from pain according to Guyton's Textbook of Medical Physiology. Pain stimuli arising from muscles can be caused by muscle damage (strain), severe cold, metabolic abnormalities, inflammation and dysfunction of the joint moved by those muscles. Hilton's Law states that a joint is innervated by the same nerve trunk that innervates the muscles which move the joint.

NSAIDs

According to a report in the New England Journal of Medicine, non-steroidal anti-inflammatory drugs (NSAIDs) caused fatal ulcers and killed about 16,500 people in 1997. If the toxic effects of NSAIDs were given its own category, it would be classified as the 15th most common cause of death in the U.S. NSAIDs cause more deaths than bone marrow cancers, asthma, cervical cancer or Hodgkin's disease and about as many as HIV/AIDS. To make matters worse, these ulcers and other gastrointestinal complications are often not preceded by warning signs. Do I have your attention?

Researchers also looked at patients who had undergone spinal fusion treatment, where two or more vertebrae are fused together, and discovered that patients who had taken a conventional NSAID (Toradol) were five times less likely to achieve successful union of the vertebrae than those who had taken no NSAID.

Safer Alternatives:

Chiropractic adjustments relieve muscle spasms by addressing the cause. There are chiropractors who will not attempt to adjust an acute subluxation, (an injured joint that is fixated and not functioning correctly) and I have patients who have been told by their medical doctor to wait until the muscle spasm subsides to be adjusted. I disagree with this. The sooner you adjust a subluxated joint, the better. No health care provider would advocate that a dislocated shoulder be left dislocated until the muscle spasm stops. Reduce the shoulder dislocation and the spasm stops. Adjust the dysfunctional joint and the local muscle spasm stops.

   The Herb Book lists Skullcap and valarian root as anti-spasmodic herbs. Bromelain taken between meals and eicosapentaenoic acid (fish oil) are good natural anti-inflammatories according to the Encyclopedia of Natural Medicine.

Concerned about the expense of chiropractic care? The rising cost of health care is a concern for nearly everyone today. We want to do our part by keeping our fees low for our patients. Our office fees are some of the lowest around. We strive to keep our overhead low so that we can pass the savings on to you.


The initial office visit is only $35.

This includes:

The consultation,

A problem focused exam,

And adjustment if indicated.

There are no hidden fees!

Follow-up office visits are only $25


This is less than most insurance co-pays.


     To help keep our overhead low and therefore our fees, we do not have an insurance billing department. We are happy to provide a receipt for you to submit to your insurance company for reimbursement.

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(660) 429-1900





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