This phenomenon, known as the “pain-spasm-pain cycle,” has not been confirmed in rigorous clinical and electrophysiologic studies. In some cases, muscle spasms themselves may become painful and debilitating. In theory, involuntary muscle spasm may result from a protective reflex preventing movement that would otherwise cause injury. The exact mechanism of action of methocarbamol remains unknown similarly unknown is the relationship between musculoskeletal pain and muscle spasm. Methocarbamol is not effective for treating contracture, rigidity, or spasticity that is believed to originate from upper motor neuron injury. Historically, methocarbamol had also been used to treat tetanus, a practice which today has been replaced by benzodiazepines. Today, clinical use is typically limited to the adjunctive treatment of acute pain of musculoskeletal origin however, off-label use has been investigated for a range of painful conditions, including acute and chronic non-specific low-back pain, inflammatory arthritides, fibromyalgia, and myofascial pain, rib fractures, perioperative care of hip and knee replacements, and abdominal muscle cramps in patients with cirrhosis. ĭespite its common use today, there are few high-quality studies and no meta-analyses comparing methocarbamol to placebo or alternative agents for muscle spasms. No significant adverse effects were noted, and only nine patients reported "minor" adverse effects, including dizziness and nausea. In the published study, all but six patients had either a "moderate" or "pronounced" response in subjective relief of pain or spasm. Concurrent with the work of O'Doherty and Shields, Forsyth described methocarbamol's efficacy in a case series of one hundred patients with orthopedic conditions, including acute and chronic disc herniation and post-operative muscle spasm. In 1958, O'Doherty and Shields described methocarbamol as an effective treatment for muscle spasms observed in individuals with pyramidal spine lesions, such as those caused by herniated intervertebral discs. Methocarbamol was discovered in the early 1950s and was approved for use in 1957. These anti-spastic and anti-spasmodic medications have different mechanisms of action for the scope of this review, we shall focus on methocarbamol. Tizanidine and diazepam have anti-spastic and anti-spasmodic properties. Other commonly prescribed anti-spasmodic agents include cyclobenzaprine and carisoprodol. As a treatment for involuntary skeletal muscle spasm, methocarbamol is considered an anti-spasmodic agent compared to anti-spastic agents like dantrolene and baclofen, which treat spasticity resulting from upper motor neuron disorders. The clinical efficacy of methocarbamol is recognized within the larger class of muscle relaxants. Methocarbamol has been approved for muscle spasms since 1957. Specific FDA indications for use are vague and have not been recently reviewed. Methocarbamol is a centrally-acting skeletal muscle relaxant (SMR) approved for the treatment of acute musculoskeletal pain.
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