Understanding Upper Back Pain
Upper back pain, which occurs in the thoracic spine region from the base of the neck to the bottom of the rib cage, is less common than lower back or neck pain [1.7.1, 1.7.2]. This area is more stable due to its connection with the ribs [1.7.6]. However, pain can still arise from a variety of causes, including:
- Muscular Irritation and Overuse: The most common causes are muscular irritation (myofascial pain) and joint dysfunction [1.7.6]. Poor posture, especially from working at a computer, muscle strains from lifting or repetitive motions, and de-conditioning can lead to pain [1.7.3, 1.7.6].
- Traumatic Injuries: Accidents, such as those from sports or car crashes, can injure the muscles, ligaments, and discs of the thoracic spine [1.7.4].
- Spinal Conditions: While less frequent in the upper back, conditions like herniated discs, osteoarthritis, spinal stenosis (narrowing of the spinal canal), and vertebral fractures can cause significant pain [1.7.1, 1.7.4].
- Referred Pain: Sometimes, pain felt in the upper back originates from other areas, such as the neck (cervical spine) or even internal organs like the heart or pancreas [1.7.5].
The Role of Muscle Relaxers
Muscle relaxers are prescription medications that act on the central nervous system (CNS) to decrease muscle tone and alleviate spasms [1.2.1, 1.3.4]. They are generally considered a second-line treatment, prescribed when first-line options like acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) fail to provide adequate relief for acute pain [1.2.3, 1.8.3].
For acute musculoskeletal back pain, a short course of muscle relaxants may be effective, especially when used as an adjunctive therapy within the first few weeks [1.2.3]. They can help break the pain-spasm-pain cycle, where pain causes protective muscle spasms that in turn cause more pain [1.2.3]. Their sedative effects can also be beneficial if the pain is disrupting sleep [1.2.3, 1.2.5]. However, evidence for long-term use is lacking, and guidelines often recommend limiting their use to two or three weeks [1.8.3, 1.8.5].
Types of Muscle Relaxers
Skeletal muscle relaxants are broadly divided into two categories:
- Antispasmodics: These are used to treat muscle spasms associated with acute, painful musculoskeletal conditions [1.4.3]. Examples include cyclobenzaprine (Flexeril), methocarbamol (Robaxin), carisoprodol (Soma), and metaxalone (Skelaxin) [1.3.2].
- Antispasticity Agents: These are used to treat spasticity (prolonged muscle tightening) from neurological conditions like multiple sclerosis, cerebral palsy, or spinal cord injuries [1.2.5, 1.4.3]. Examples include baclofen and dantrolene [1.3.2]. For musculoskeletal back pain, antispasmodic agents are the appropriate choice [1.8.3].
Common Prescription Muscle Relaxers
| Medication (Brand Name) | Primary Use | Common Side Effects | Key Considerations |
|---|---|---|---|
| Cyclobenzaprine (Flexeril, Amrix) | Short-term relief of muscle spasms from acute painful conditions [1.3.1, 1.3.2]. | Drowsiness, dry mouth, dizziness, fatigue, constipation [1.3.1, 1.4.5]. | Highly studied and effective, but has significant sedative effects. Not recommended for elderly patients [1.8.3]. |
| Methocarbamol (Robaxin) | Treatment for muscle spasms and pain [1.3.1]. | Dizziness, drowsiness, lightheadedness, blurred vision [1.3.1, 1.4.5]. | Considered one of the less sedating options compared to others like cyclobenzaprine [1.3.1]. |
| Metaxalone (Skelaxin) | Acute, painful musculoskeletal conditions [1.3.2]. | Drowsiness, dizziness, headache, nervousness [1.4.5]. | Known for having a lower incidence of side effects, particularly drowsiness, but can be more expensive [1.3.2]. |
| Tizanidine (Zanaflex) | Used for muscle spasms, often for back and neck pain [1.3.1]. | Drowsiness, dry mouth, weakness, dizziness, potential for liver toxicity [1.3.2, 1.4.5]. | Can cause dose-related hypotension (low blood pressure) [1.8.3]. |
| Carisoprodol (Soma) | Short-term treatment for acute painful muscle conditions [1.3.2]. | Drowsiness, dizziness, headache [1.4.5]. | Has a potential for abuse and dependence; it is a Schedule IV controlled substance [1.3.1, 1.4.4]. Use is limited to 2-3 weeks [1.4.4]. |
Risks and Side Effects
The effectiveness of muscle relaxants comes with a significant risk of side effects. Because they depress the central nervous system, the most common side effects include drowsiness, dizziness, and fatigue [1.2.3, 1.4.7]. These effects can impair your ability to drive or operate heavy machinery and increase the risk of falls, especially in older adults [1.2.3, 1.4.2]. The American Geriatrics Society advises against their use in people over 65 [1.2.1].
Other potential side effects include:
- Dry mouth [1.4.5]
- Headache [1.2.1]
- Confusion [1.2.1]
- Nausea and constipation [1.3.1]
Serious risks include dependency, abuse, and overdose, which can lead to respiratory depression and can be fatal, especially when combined with other CNS depressants like alcohol or opioids [1.2.3, 1.4.4, 1.4.6]. If you have been taking a muscle relaxant for an extended period, you should not stop abruptly, as this can cause withdrawal symptoms like nausea and trouble sleeping [1.2.3].
Alternatives to Muscle Relaxers
Given the risks, it's crucial to explore other treatment avenues. In almost every case of back pain, conservative methods should be tried first [1.2.1].
Over-the-Counter (OTC) Medications
- NSAIDs: Drugs like ibuprofen (Advil, Motrin) and naproxen (Aleve) are often the first choice as they reduce both pain and inflammation [1.5.2, 1.5.3]. Naproxen has a longer duration of action (8-12 hours) compared to ibuprofen (4-6 hours) [1.3.1].
- Acetaminophen (Tylenol): Focuses on relieving pain but does not target inflammation [1.3.2]. It is often considered a safe option with minimal stomach irritation [1.5.2].
Non-Pharmacological Treatments
- Physical Therapy and Exercise: This is the foundation of treating back pain. A physical therapist can provide tailored exercises to strengthen core muscles, improve flexibility, and correct posture [1.5.1].
- Heat and Ice Therapy: Applying heat can help relax tense muscles, while ice can reduce inflammation and numb the area [1.7.1].
- Lifestyle Modifications: Maintaining a healthy weight, practicing good posture, taking breaks from prolonged sitting, and quitting smoking can significantly reduce back pain [1.5.1, 1.7.5].
- Alternative Therapies: Acupuncture, massage therapy, and chiropractic care may provide relief for some individuals [1.5.3, 1.5.5].
- Natural Remedies: Some people find relief with topical applications like arnica or essential oils (peppermint, lavender), or supplements like magnesium [1.5.5, 1.5.6].
Conclusion
So, are muscle relaxers good for upper back pain? They can be, but only as a short-term, adjunctive treatment for acute muscle spasms that haven't responded to safer, first-line therapies like NSAIDs and physical therapy [1.2.3, 1.8.3]. Their effectiveness is modest and comes at the cost of significant side effects, including drowsiness, dizziness, and the risk of dependence [1.2.2, 1.4.3]. They should be used with caution, especially in older adults, and never combined with alcohol or other sedating drugs [1.2.1, 1.4.6]. The most sustainable path to managing upper back pain involves addressing the root cause through exercise, posture correction, and other non-pharmacological strategies [1.5.1]. Always consult a healthcare professional to determine the best treatment plan for your specific condition. For more information on non-surgical treatments, Johns Hopkins Medicine offers a comprehensive guide.
