Are Muscle Relaxers Addictive? Risks and Uses For Muscle Relaxers

Muscle relaxers are addictive; some are controlled substances due to their high potential for addiction, while others are only recommended for short-term use. Signs of an addiction to muscle relaxers may include taking more than the prescribed dose or taking it more frequently. To safely use muscle relaxers, only take them as prescribed and treat short-term, acute musculoskeletal problems.

What are muscle relaxers?

Muscle relaxers are prescription medications that treat symptoms of muscle problems such as muscle spasms and musculoskeletal pain.[1] There are two different types of drug classes for muscle relaxants: antispastic and antispasmodic.

Antispastic muscle relaxers work directly on the skeletal muscles or the spinal cord to improve muscle hypertonicity and involuntary spasms.[2]  Spasticity is a pattern of muscle movements that increases stiffness and leads to undesired, uncontrolled movements. It is usually a result of damage to the nerve pathways in the brain or spinal cord, which control muscle movement and stretch reflexes.

Certain medical conditions can cause spasticity, such as [3]

• Cerebral palsy
• Multiple sclerosis
• Spinal cord injury
• Stoke
• Brain injury
• Lou Gehrig’s disease (ALS)

Antispasmodic skeletal muscle relaxers decrease muscle spasms by altering the conductions in the central nervous system. They are prescribed for musculoskeletal and myofascial pain, most often lower back pain and muscle spasms.[4]  They are typically prescribed as an alternative to treat pain after other medications have been unsuccessful. This is because of their high propensity for misuse and abuse.

Muscle relaxants are a relatively frequent prescription as acute and chronic back pain is a common ailment. Low back pain is among the top five reasons people see their primary healthcare provider. Most people’s lower back pain resolves independently or with over-the-counter medications. Providers usually only prescribe muscle relaxants after other treatments have been unsuccessful in treating the person’s pain. When they are prescribed, they are for short periods due to the addiction potential muscle relaxants have.

How Do Muscle Relaxants Work?

Muscle relaxants are central nervous system depressants. They have a sedative effect that prevents nerves from sending pain signals to your brain.

Antispastic muscle relaxants work directly on the skeletal muscle or spinal cord to improve muscle tightness and prevent involuntary spasms.

Antispasmodic muscle relaxants reduce muscle spasms by acting on the central nervous system.

Types of Muscle Relaxers

Common antispasmodic skeletal muscle relaxants drug names and brand names include [5]

• Carisoprodol (Soma, Vanadom)
• Chlorzoxazone (Lorzone, Parafon Forte DSC, Relax-DS, Remular S)
• Cyclobenzaprine (Fexmid, Flexeril)
• Metaxalone (Metaxall, Skelaxin)
• Methocarbamol (Robaxin)
• Orphenadrine (Norflex)

Common antispastic skeletal muscle relaxants drug names and brand names include [6]

• Baclofen (Lioresal)
• Dantrolene (Dantrium)

Two muscle relaxants are both antispasmodic and antispastic. They are [7]

• Tizanidine (Zanaflex)
• Diazepam (Valium)

Uses For Muscle Relaxers

Antispasmodic muscle relaxers are effective in treating muscle pain and spasms. However, high doses can result in undesirable side effects. Antispasmodics can be more effective in treating muscle pain and spasms than NSAIDS and acetaminophen, but they do have more side effects. Before taking muscle relaxants, talking to your healthcare provider about the risks and benefits of taking the medication is important.

Risks of Taking Muscle Relaxers

Each muscle relaxant medication has different potential side effects. It is important to talk to your healthcare provider about any potential side effects you may experience.

Common side effects shared by most muscle relaxants include [8]

• Drowsiness and fatigue
• Dizziness
• Nausea
• Headache
• Dry mouth

Serious side effects from muscle relaxants can include [9]

• Fainting
• Blurred Vision
• Seizures
• Sedation that prevents the completion of daily tasks

How Often Are Muscle Relaxants Prescribed?

Muscle relaxants are increasingly being prescribed for low back pain or chronic back pain despite not being recommended as the primary treatment. If they are used as a treatment after other treatments have failed, they should be for short-term use. The recommended duration of use is a maximum of three weeks.[10] After that, there is little evidence that they are an effective treatment for muscle spasms.

Despite this, research shows that 35% of patients are prescribed muscle relaxants for non-specific low back pain, and 18.5% receive muscle relaxers as their initial treatment.[11] Another research study found that between 2005 and 2016, while new prescriptions remained the same at six million per year, continued muscle relaxant prescriptions increased from 8.5 million in 2005 to 24.7 million in 2016.[12] There is a lack of research on muscle relaxers’ long-term efficacy and consequences.

Are Muscle Relaxers Addictive?

The muscle relaxers carisoprodol and diazepam are controlled substances. They are controlled substances due to their risk of addiction and the potential of developing dependence, causing withdrawal symptoms when you attempt to stop taking them.

The remaining muscle relaxers are not controlled substances and generally have a lower potential for addiction. You should only take muscle relaxants as prescribed to reduce your risk of developing an addiction. If you believe your current dose of muscle relaxants is no longer effective, you should speak to your medical provider. You should not adjust the amount or frequency of the medication.

Other Risks

There are two main risks when taking muscle relaxers. They have the potential for overdose and the potential for interactions with alcohol, which can be dangerous.

Muscle Relaxers and Overdose

Muscle relaxers, especially carisoprodol and diazepam, have a high risk for misuse and addiction. Using muscle relaxants over an extended period increases one’s risk of developing tolerance and physical dependence.

Symptoms of a muscle relaxant overdose include [13]

• Changes in consciousness
• Hallucinations
• Seizures
• Respiratory depression
• Cardiac arrest
• Coma
• Death

If you or a loved one are taking a muscle relaxant and experiencing any of the above overdose symptoms, seek immediate medical attention. Overdose symptoms can be life-threatening, and rapid medical intervention is necessary. Call 911 or go to the nearest emergency department immediately.

Muscle Relaxers and Alcohol

You should not consume alcohol if you have been prescribed muscle relaxers. Both muscle relaxers and alcohol are depressants, slowing down your central nervous system. Consuming them both at the same time can worsen the side effects and increase the risk of overdose.

Possible symptoms of combining alcohol and muscle relaxants include [14]

• Extreme dizziness.
• Extreme drowsiness.
• Blurred vision.
• Low blood pressure.
• Fainting.
• Memory problems.
• Liver damage.
• Increased risk of overdose

What are the Signs of Addiction to Muscle Relaxers?

Skeletal muscle relaxants misuse or abuse resulted in 53,000 emergency department visits in 2011. [15] 18% of those visits were due to complications of mixing muscle relaxers with alcohol. Muscle relaxers were used in 4.8% of suicide attempts. This is an 84% increase since 2004. There has been a significant jump in muscle relaxer prescriptions in the United States. If you or a loved one is prescribed a muscle relaxant, you should understand the risks and benefits and the potential for addiction.

Understanding the terms of addiction can also help assess for signs of an addiction to muscle relaxers.

• Misuse: Misuse is taking a muscle relaxer for a reason other than what it was prescribed for, such as using it as a sleep aid rather than treating the muscle spasms it was prescribed for. Misuse also includes taking a higher dose or taking it more frequently than prescribed.
• Abuse: Abuse is intentionally taking a muscle relaxant for a non-medical reason to have a desirable effect. For example, taking it to numb emotional pain.
• Dependence: Dependence can occur when you have used a medication for a significant amount of time and have become physically dependent on it. Having a physical dependence on a drug means you can not stop taking it without experiencing withdrawal symptoms. If you believe you have become physically dependent on a muscle relaxer, you need to work closely with your healthcare provider to determine a schedule to wean off the medication safely.
• Tolerance: If you have used a muscle relaxer for a long period, you may develop a tolerance. Having a tolerance to a muscle relaxant means you need a higher dose to achieve the same therapeutic effects that you were able to have with a lower dose earlier on.
• Withdrawal: Withdrawal symptoms happen if you stop taking a muscle relaxant abruptly or reduce your dosage quickly. Muscle relaxant withdrawal symptoms can include headache, nausea, vomiting, drowsiness or insomnia, tremors, anxiety, depression, agitation, and aggression.[16]

Muscle Relaxants Have a High Risk for Addiction

Skeletal muscle relaxers can be effective medications for treating acute nonspecific back pain for a short period. More research is needed to determine their safety and efficacy for long-term use. Long-term use increases your risk for misuse, abuse, and addiction.

If you believe you or a loved one has been using muscle relaxers for too long or at too high a dose, you should speak to your healthcare provider about alternative treatments and how to safely reduce or eliminate your use of muscle relaxers.