Many people who have pain complain of tight muscle spasms, knots or bands in or near the pain’s location. If a person has neck or low back pain, they often feel like the muscles in their neck and back are extremely stiff and tender. This occurs because the muscles near the pained region tighten up in an effort to limit movement in that area. Just like a cast protects your broken ankle, your body attempts to shield itself from more pain. Acutely, this serves a purpose to protect a structure from moving when injured. Chronically, this is a maladaptive response. Movement maintains blood flow, strength and flexibility.
People with chronic pain often notice they have lost flexibility and find that muscles in the painful area tight and tender. Patients often want a pill to treat the muscle tightness; a quick solution. Tight muscles hurt when one tries to be active and reduce our ability to move smoothly. In response to the demand, doctors often prescribe muscle relaxers; medications that are supposed to reduce muscle tightness. There are many drugs that affect muscle tightness, but most are good only in acute situations, and for a very short time. For chronic muscle issues, most of the medications are minimally effective.
Muscle Medications
The medications that are most often used for chronic muscle spasms are drugs which also diminish pain signals in some way. Benzodiazepines (like valium, Ativan, and Xanax) act on the central nervous system to reduce signal transmission and enhance the compound GABA that influences pain sensation. Unfortunately, these compounds are highly addictive and lose effectiveness quickly. They are most helpful in acute situations only. Baclofen and tizanidine are also centrally acting, and they prevent muscles from tightening up and decrease pain signals. These two are not addictive, but only work for some patients and each can have its own serious side effects. Flexeril (cyclobenzaprine) originally was developed to be an antidepressant, but its central acting turned out to relax muscles, however, it’s very sedating, inducing deep sleep and is best used only at night. There are multiple other medications also available, but few are helpful except for acute injury type pain.
Muscle tightness and spasms in chronic situations are best treated without medications. The best treatment is stretching and strengthening the muscles and area. It seems counter-intuitive to exercise sore muscles, but this is the most effective management. Physical therapy is excellent to learn the appropriate exercises. Massage and chiropractic adjustment can also be useful. However on a long-term basis, it is up to the individual to do the exercises, daily stretching and strengthening. If you have chronic pain issues, the best treatment is to do the work and over time the pain will get better. There are no shortcuts when doing the maintenance to stay healthy.