The indications, dosages, precautions and other properties of skeletal muscle relaxants are summarized in Table 1. Because antispastics and antispasmodics work in the central nervous system, their side effects can pose a unique risk to geriatric patients. Compared to the average adult, geriatric patients have an increased risk of falls due to dangerous gait, loss of coordination or muscle strength, and other age-related decreases in mobility and cognition. Common side effects of antispastic and antispasmodic drugs are dizziness, drowsiness and hypotension; Therefore, a geriatric patient`s risk of falls and fractures may increase when skeletal muscle relaxants are used. One study showed that geriatric patients who took muscle relaxants were 2.25 times more likely to go to the emergency room for a fall or fracture and 1.56 times more likely to be hospitalized for a fall or fracture than patients who did not take these drugs.15 Another study found that users of skeletal muscle relaxants over the age of 65 were 1.32 times more likely to have an injury that patients who did not use a skeleton. Muscle relaxants. Specifically, patients taking carisoprodol, cyclobenzaprine, and methocarbamol, respectively, were 1.73 times, 1.22 times, and 1.42 times more likely to suffer injuries than patients without skeletal muscle relaxants.16 Recent studies have shown that a type of skeletal muscle relaxants (SMRs), called antispasmodics, outperforms anti-inflammatory drugs (NSAIDs) such as ibuprofen and paracetamol. to relieve severe pain associated with diseases such as acute back pain. On the other hand, they also have potentially more serious side effects and should not be used for long-term pain management. Yet, these prescription drugs are effective and reliable options for short-term pain relief. So you`ve sprained your lower back and pulled tires, a stressful work week has triggered a number of tension headaches, and arthritis makes you wake up with stiffness and neck pain. What else? Tense and sore muscles can be frustrating and distracting, throwing a key into your schedule.
If muscle pain occurs, you can look for quick-acting relief so you can continue to live. Whether you have back pain, muscle spasms, arthritis, chronic pain from injuries, or even TMJ, muscle relaxants provide quick pain relief so your body can function as usual. Consider this guide as your roadmap to the best muscle relaxants on the market. The National Institute for Health and Care Excellence (NICE) guidelines for the treatment of multiple sclerosis, the most common cause of spasticity, recommend physical therapy for the treatment of spasticity in all patients. Drug therapy is only recommended if spasticity causes pain, significant discomfort, loss of autonomy, or restrictions on activities.13 For patients who experience side effects with muscle relaxants, it may be beneficial to discuss alternative options such as physiotherapy, physical therapy, or with a muscle relaxant if necessary. Patients should be informed of the potential for falls and other adverse events and encouraged to weigh the pros and cons of taking a skeletal muscle relaxant. Another way to reduce the burden of medication and thus reduce the risk of falling would be to adapt the therapy to the time of day when muscle relaxation is needed. Often, patients do not need medication when walking and are active, but they may need relaxation when they go to bed, as changing position can worsen spasticity. First-line treatment (baclofen) and second-line treatment (dantrolene) according to NICE guidelines are not on the beer criteria list, but both drugs can increase the risk of falling.13 Tizanidine, the other second-line treatment, is on the list of beers due to possible urinary retention and may also increase the risk of falling.3, 12 SUMMARY: Declining geriatric patient numbers cost the United States billions of dollars each year and contributes to morbidity and mortality in this population.
Polypharmacy can contribute significantly to the risk of falling, especially drugs that are on the beer criteria list. Skeletal muscle relaxants are on this list, and an increased risk of falling is associated with their use. These drugs are used inappropriately as an alternative to traditional painkillers and can be just as harmful as opioids in the geriatric population. Education of patients and prescribers is necessary to prevent inappropriate use of muscle relaxation and reduce the risk of falling. Meaning Little is known about national trends in the prescribing of skeletal muscle relaxants (SMRs), the use of which is associated with significant safety concerns, particularly in the elderly and in patients using concomitant opioids. Recent literature analyzing the prevalence of muscle relaxant use is scarce. Some clinicians will agree that drugs in this class tend to be used more often than necessary, but clear data is lacking. DATA from IMS Health from 2003 to 2004 showed that carisoprodol, cyclobenzaprine, and metaxalone accounted for more than 45% of all prescriptions for the treatment of musculoskeletal pain.9 Dillon et al. tried to define the United States. Usage patterns using data from the Third National Health and Nutrition Survey (NHANES III).10 In this cross-sectional prevalence study, the authors concluded that about two million adults in the United States used skeletal muscle relaxants. Interestingly, the study found that although two-thirds of patients taking these remedies had a recent history of back pain, the prevalence of these drugs was only 4% among all participants who reported back pain in the previous year (95% CI, 2.9% to 5.2%). In addition, the study showed that 44.5% of users took muscle relaxants for more than a year (95% CI, 35.7% -53.3%).
This result is worrisome because each remedy is only recommended for short-term use and has not yet been studied in chronic management. Sociodemographic analysis of the data shows that the average age of users was 42.3 years (95% CI 38.1 to 47.8 years) and that 16% were over 60 years of age.10 Although the results of this study provide data on the use of muscle relaxants, it is important to remember that the NHANES III survey contains information from 1988 to 1994. The American Pain Society and the American College of Physicians published guidelines for back pain in 2007 that recommended acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line treatment for most patients. This recommendation is primarily due to the favorable side effect profile of these agents compared to other options as opposed to superior efficacy.1 After the failure of a first-line remedy, skeletal muscle relaxants, benzodiazepines, and opioids may be initiated based on evidence of additional temporary pain relief.1 Depending on the reason for use, there are several alternative therapies to skeletal muscle relaxants. TABLE 3 provides an overview of possible alternatives.17 For patients with back pain, it is important to understand that most pain goes away on its own and does not require medical treatment. In the United States, an estimated 29 million falls occurred in 2014 in 46 million people over the age of 65, and 7 million of these falls resulted in injuries.1 In 2015, the estimated medical costs associated with fatal and non-fatal falls were more than $49 billion.2 It is estimated that the geriatric population in the United States will increase to 74 million by 2030. and 49 million falls are expected (12 million of which cause injuries).1 Known risk factors for falls in geriatric patients include polypharmacy and drug side effects. Community pharmacists are uniquely positioned to reduce the costs associated with falls and increase patient safety by reviewing prescriptions for high-risk drugs before these drugs are given to their patients.
One class of drugs with the potential for inappropriate prescribing in geriatric patients are skeletal muscle relaxants.