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Is There Evidence To Prescribe Cyclobenzaprine For Long-Term Pain Management?

Friday 9 March 2018

 

From Practical Pain Management:

 

Tablets
 

Ask the Expert: Is there evidence to prescribe cyclobenzaprine for long-term pain management?

Long-term use of cyclobenzaprine requires further study to confirm its efficacy.

By Pratik Patel, PharmD Candidate and McKenzie C. Ferguson, PharmD, BCPS
Practical Pain Management: March 2018 Volume 18, Issue #2
©1999 - 2018 Vertical Health LLC

Cyclobenzaprine is a commonly prescribed oral skeletal muscle relaxant for the treatment of painful musculoskeletal conditions.1 Several studies have shown favorable evidence in using cyclobenzaprine to treat various muscular conditions, including fibromyalgia, neck pain, and lower back pain.2,3 Most studies evaluating the efficacy and safety of cyclobenzaprine were indicated for short-term use (< 20 days).1-3 There are limited data for longer term use (> 21 days) of cyclobenzaprine for conditions of fibrositis and fibromyalgia.3,4 Data from these studies may be difficult to extrapolate use of cyclobenzaprine for other chronic pain conditions, but more studies evaluating efficacy and safety for long-term use in various conditions have emerged.5

Potential Pain Applications for Cyclobenzaprine

A very low dose, sublingual (SL) formulation of cyclobenzaprine is under development by Tonix Pharmaceuticals (New York, NY). This formulation is thought to increase the rate of absorption, compared to an oral tablet, and bypass first-pass metabolism in the liver.5

Cyclobenzaprine is structurally similar to tricyclic antidepressants, which may help predict its potential long-term use in various neurological conditions, such as fibromyalgia and mood imbalances.6 Common adverse effects that may limit or challenge long-term use of cyclobenzaprine include somnolence, dry mouth, and dizziness.1 From a case report, the authors suggested that due to cyclobenzaprine’s tricyclic properties, it may also be associated with symptoms of serotonin-syndrome when combined with potentiating drugs.7 Currently, SL, very low dose cyclobenzaprine is being studied in patients with fibromyalgia and post-traumatic stress disorder (PTSD).5

In a separate double-blind study,8 patients with fibromyalgia were assessed for efficacy of very low dose cyclobenzaprine in relieving pain symptoms and sleep dysfunction over eight weeks. Thirty-six patients (97% women) were randomized to either receive 1 mg or 4 mg of cyclobenzaprine once nightly or placebo. Symptoms of pain, tenderness, fatigue, moods, and sleep physiology were evaluated from baseline to two months. Pain, fatigue, and tenderness were measured using seven point ordinal scales (0 to 6) with 6 being the worst possible discomfort. Sleep physiology was analyzed with sleep electroencephalography (EEG). Mean pain scores decreased from 2.3 to 1.7 in the cyclobenzaprine group against no change in patients in the placebo group. Overall, patients in the cyclobenzaprine group experienced improvements in pain scores.8

 

Full article…

 


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