The Therapeutics Initiative (TI) from The University of British Columbia provides a bi-monthly publication called the "Therapeutics Letter" that identifies problematic therapeutic issues and, after a literature review and approval from therapeutic specialists, develops messaging to share with health care providers.
The most recent publication posed the question: “Is cyclobenzaprine (also known as Flexeril), useful for pain?"
A response came in the form of a review of the evidence for benefits and harms of cyclobenzaprine for common pain indications, compared with placebo. Here are some facts (don't forget to check our Quick Links section for more evidence and a list of sources for evidence provided throughout this article):
- In B.C., cyclobenzaprine is prescribed for acute pain at higher doses and for longer durations than necessary, and is frequently prescribed for unapproved long term use.
- There is no compelling evidence that cyclobenzaprine is a muscle-relaxant. Effects on pain or overall function are likely the result of sedation.
Along the same vein, Cochrane reviewed muscle relaxants for pain management in rheumatoid arthritis and concluded that they did not significantly reduce pain over two weeks, however, even short term muscle relaxant use (24 hours to 2 weeks) is associated with significant adverse events, predominantly drowsiness and dizziness.
- If prescribed, a dose of 5 mg at bedtime should be tried first. Evidence suggests titration based on response and tolerability to a maximum dose of 15 mg/day, for no longer than one week.