Program in Addiction Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut.
Fair Haven Community Health Care, New Haven, Connecticut.
JAMA Netw Open. 2024 Sep 3;7(9):e2434835. doi: 10.1001/jamanetworkopen.2024.34835.
Stricter opioid prescribing guidelines have increased prescriptions of skeletal muscle relaxants (SMRs) for chronic pain, but the efficacy of long-term use of SMRs for chronic pain is unknown.
To systematically review the effectiveness or efficacy of long-term use of SMRs for chronic pain.
Two reviewers systematically searched Ovid MEDLINE, Embase (Ovid), Web of Science, CINAHL, and Cochrane through December 4, 2023. They included articles published in English, Spanish, or Italian. Only randomized clinical trials (RCTs) and cohort studies with comparator groups evaluating at least 1-month duration of SMRs for chronic pain were included. The reviewers dually reviewed data abstraction, risk-of-bias, and quality. They characterized studies by chronic pain syndrome: low back pain, fibromyalgia, headaches, painful cramps or spasticity, and other syndromes.
A total of 30 RCTs with 1314 participants and 14 cohort studies with 1168 participants assessed SMRs for chronic pain. Studies were primarily short-term (4-6 weeks). Nine unique SMRs were represented by the studies identified. Eleven studies (25%) examined baclofen, 8 (18%) examined tizanidine, and 7 (16%) examined cyclobenzaprine. Evidence for effectiveness was strongest for SMRs used for trigeminal neuralgia, neck pain, and painful cramps; evidence suggested SMRs for fibromyalgia, low back pain, and other syndromes were not more beneficial than placebo. The most common adverse effects were sedation and dry mouth. RCTs had a low to moderate risk of bias, and the quality of cohort studies was fair to good.
In this systematic review of long-term use of SMRs for chronic pain, findings suggest that their long-term use may benefit patients with painful spasms or cramps and neck pain; their long-term use for low back pain, fibromyalgia, and headaches did not appear to be beneficial. Clinicians should be vigilant for adverse effects and consider deprescribing if pain-related goals are not met.
更严格的阿片类药物处方指南增加了用于慢性疼痛的骨骼肌松弛剂（SMR）的处方数量，但长期使用 SMR 治疗慢性疼痛的疗效尚不清楚。
系统评价长期使用 SMR 治疗慢性疼痛的有效性。
两位审查员系统地检索了 Ovid MEDLINE、Embase（Ovid）、Web of Science、CINAHL 和 Cochrane，检索时间截至 2023 年 12 月 4 日。他们纳入了发表在英语、西班牙语或意大利语的文章。仅纳入了评估 SMR 治疗慢性疼痛至少 1 个月的随机临床试验（RCT）和队列研究，且这些研究具有对照组。审查员双重审查了数据提取、偏倚风险和质量。他们根据慢性疼痛综合征对研究进行了分类：下腰痛、纤维肌痛、头痛、疼痛性痉挛或肌强直、以及其他综合征。
共有 30 项 RCT 纳入了 1314 名参与者，14 项队列研究纳入了 1168 名参与者，评估了 SMR 治疗慢性疼痛。这些研究主要为短期（4-6 周）研究。研究中涉及 9 种独特的 SMR。有 11 项研究（25%）评估了巴氯芬，8 项研究（18%）评估了替扎尼定，7 项研究（16%）评估了环苯扎林。有证据表明 SMR 对三叉神经痛、颈痛和疼痛性痉挛有效，而对纤维肌痛、下腰痛和其他综合征的疗效并不优于安慰剂。最常见的不良反应是镇静和口干。RCT 的偏倚风险为低到中度，队列研究的质量为良好到中等。
在这项关于 SMR 长期治疗慢性疼痛的系统评价中，结果表明，其长期使用可能有益于患有疼痛性痉挛或抽搐和颈痛的患者；但对下腰痛、纤维肌痛和头痛的长期使用似乎无益。如果疼痛相关目标未达到，临床医生应警惕不良反应，并考虑停药。
