Muscle Relaxants and the Long Road Back to Work: Why Short-Term Relief Should Not Become Long Term Risk
Summary:
While muscle relaxants can provide short term relief from sudden muscle pain, their long-term safety and effectiveness remain uncertain. This blog explores the risks of prolonged use, current guideline recommendations, and the impact these medications can have on recovery and return to work. Understanding when these medications help and when they may hinder progress is essential for supporting both patient safety and successful return to activity.
Introduction
Skeletal muscles work with bones, ligaments, and connective tissues to support movement and stability. These muscles rely on signals from the central nervous system to contract and relax. When exposed to strain, dehydration, repetitive motions, or sudden injury, muscles can spasm and cause significant pain. Persistent spasms can disrupt normal function and, in severe cases, may contribute to long term issues involving the brain, spinal cord, or motor nerves [1].
Work related musculoskeletal disorders remain one of the most frequent causes of missed workdays and lost productivity. In 2018, nearly one third of all workers compensation cases were linked to musculoskeletal injuries [2]. Because these injuries often cause acute discomfort and functional limitations, muscle relaxants are frequently prescribed with the hope of offering fast symptom relief.
Intended Role of Muscle Relaxants
Commonly used muscle relaxants include baclofen, cyclobenzaprine, methocarbamol, carisoprodol, and tizanidine. These medications reduce muscle spasm and ease pain caused by acute musculoskeletal injury, low back pain, or sudden strain [3]. Each medication works through a slightly different mechanism, but most share a central nervous system effect that slows motor activity and decreases involuntary muscle contractions.
Cyclobenzaprine and methocarbamol act within the central nervous system to reduce motor neuron activity. Tizanidine reduces release of excitatory neurotransmitters. Baclofen activates GABA receptors, which helps decrease muscle spasticity [4]. These mechanisms can help with short term pain relief, but they also create risks.
Because muscle relaxants depress the central nervous system, they may cause sedation, dizziness, slowed reaction times, and impaired coordination [4]. When taken with opioids, these effects can intensify and may increase the risk of respiratory depression and overdose. This combination can be particularly concerning in workers recovering from injury who may already be dealing with pain, limited mobility, or fatigue.
Clinical recommendations state that muscle relaxants should be used only when acetaminophen or nonsteroidal anti-inflammatory drugs are not effective or tolerated, and that treatment should be limited to two or three weeks [5,6]. Their role is intended to be temporary, not chronic.
Guideline Recommendations
The American College of Physicians identifies nonpharmacological treatment as the first step in managing acute and subacute low back pain. If symptoms persist, nonsteroidal anti-inflammatory drugs or muscle relaxants may be considered [7]. However, research shows that nonsteroidal anti-inflammatory drugs offer small improvements in pain and function, while muscle relaxants provide only modest short term pain relief with limited improvement in functional ability. Sedation is a significant and consistent side effect [7].
The American Academy of Family Physicians reinforces this approach, stating that muscle relaxants are not considered first line therapy and should instead be used as adjunct treatment for acute low back pain when appropriate [5]. These guidelines highlight the temporary nature of their use and the importance of balancing benefits with well-known risks.
Long Term Efficacy and Safety Concerns
Despite their widespread use, the long-term effectiveness of muscle relaxants remains unclear. Many clinical trials evaluate only short-term outcomes, which leaves limited evidence for chronic use. Even with this lack of evidence, prescribing trends have continued to increase over recent years [8].
A 2024 systematic review across forty-four studies found that long term benefit was inconsistent. Some benefit may exist for conditions involving neck pain or painful cramps, but there was no strong evidence supporting use for chronic headache, fibromyalgia, or persistent low back pain [3]. This uncertainty adds to existing concerns about long term safety.
Muscle relaxants are known to cause sedation, dizziness, blurred vision, and impaired balance. Over time, these effects can significantly increase the risk of falls and fractures, particularly in older adults [9]. For this reason, the American Geriatrics Society includes muscle relaxants in the Beers Criteria list of medications that older adults should avoid due to anticholinergic burden, sedation, and injury risk [10].
Carisoprodol presents another concern due to its potential for misuse and dependence. When combined with opioids or other central nervous system depressants, the risk of overdose and harmful drug interactions increases [11]. Because of these risks, long term prescribing should be approached cautiously and reconsidered during follow up visits.
Implications for Worker’s Compensation
Returning to work after a musculoskeletal injury requires adequate pain control, restored mobility, and clear mental alertness. Although muscle relaxants may offer temporary relief, their adverse effects can interfere with physical recovery and workplace safety.
Sedation, slowed reactions, limited coordination, and dizziness can be especially concerning for workers in positions requiring lifting, driving, climbing, operating machinery, or maintaining situational awareness. For these individuals, even mild impairment can pose a safety risk to themselves and coworkers. Instead of supporting a faster return to work, prolonged use of muscle relaxants may slow progress, increase risk of further injury, and delay overall recovery [5].
For employers and workers compensation programs, these concerns highlight the importance of evaluating whether the benefits of muscle relaxants outweigh the risks on an ongoing basis. Safer alternatives may include physical therapy, nonmedication strategies, nonsteroidal anti-inflammatory drugs, or return to work plans with gradual activity increases.
Key Takeaways
Muscle relaxants should be prescribed with care and used only for short periods. Their effectiveness is generally limited to short term pain relief, and long term benefits remain unproven. Meanwhile, their risks, including sedation, dizziness, impaired coordination, and potential for dependence, become more concerning with extended use.
Guidelines from both the American College of Physicians and the American Academy of Family Physicians recommend limiting muscle relaxants to two or three weeks and using them only when other therapies fail to provide relief [7,5]. For workers recovering from injury, minimizing long term use supports safer recovery and helps individuals return to work without added medication related risks.
By Melissa Koesters
PharmD Candidate (P4)
For questions, e-mail pharmd@prodigyrx.com
Citations
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2. Bureau of Labor Statistics, U.S. Department of Labor. Occupational injuries and illnesses resulting in musculoskeletal disorders. Updated May 1, 2020. Accessed March 10, 2026. https://www.bls.gov/iif/factsheets/msds.htm
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https://doi.org/10.1016/j.jpainsymman.2004.05.002
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6. U.S. Food and Drug Administration. Cyclobenzaprine Label. Updated 2003.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2003/017821s045lbl.pdf
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https://www.aafp.org/pubs/afp/issues/2017/0915/p407.html
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https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767631
9. Golden AG, Ma Q, Nair V, Florez HJ, Roos BA. Risk for fractures with centrally acting muscle relaxants: An analysis of a national Medicare Advantage claims database. Ann Pharmacother. 2010;44(9):1369 1375. doi:10.1345/aph.1P210 https://journals.sagepub.com/doi/10.1345/aph.1P210
10. The Care Partner Project. The Beers List. Accessed March 10, 2026.
https://thecarepartnerproject.org/wp-content/uploads/The-Beers-List.pdf
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