Muscle relaxants don’t work. What will it take to change pain management?

If you Google “muscle relaxant”, one of the articles that pop up is about lower back pain treatment. According National Heart Centre, muscle relaxants can help with reducing muscle spasm and stiffness.

Do they help though?

Do muscle relaxers help back pain?

muscle relaxant billion dollar market
Muscle relaxants were identified as an emerging trend and forecasted to be a billion-dollar market this year!

The latest study involving 6505 patients from 31 clinical trials showed that muscle relaxants DO NOT work.

While muscle relaxants can indeed lead to small improvements for patients, these changes are too small to be clinically meaningful.

What that means is that we can use instruments to objectively measure a change in patient’s pain experience. However, they change is so small that it’s not enough for the patient to experience any subjective improvement.

What is clinically meaningful change?

80 year old man with sciatica
If you think there are treatments that will work better than exercises, you are probably in denial. Research has for years now told us there isn’t. Yes, you may not be ready to consider exercise now. But it doesn’t change that exercise plus education is the best treatment you can get for your pain.

For a treatment to be clinically meaningful, its effect size needs to be big enough for the patient to experience a benefit.

Imagine yourself baking a chocolate cake. If you were to use only one granule of sugar, instead of two cups that the recipe calls for, do you think your cake will be sweet?

Probably not. But objectively, we know there is sugar in it.

In short, don’t bother popping the muscle relaxer to help with your neck and shoulder pain. It’s not effective enough for you to feel a difference.

Clinical guidelines never recommended medication in the first place.

clinical recommendation medication
Medications are really not looking too good for pain management. While NSAIDs do remain on the list as second-line treatment, there are other safer options to choose from.

It is crazy that we are still discussing this. Even crazier that medical practitioners still regularly prescribed muscle relaxants.

People call chiropractors out for being alternative medicine and practising outside of science. However, mainstream medicine is not always doing much better.

Singapore General Hospital, ranked 3rd in the world in 2019, still suggests that NSAIDs and muscle relaxants can help with back pain.


If The Lancet‘s recommendations were not clear enough, muscle relaxers did not even make it to UK NICE guideline for low back pain and sciatica.

What is the most effective pain reliever?

low back pain clinical guideline, lancet low back pain
Exercise is nobody’s first choice treatment for chronic pain. Yet research tells us exercise plus education your best shot.

Honestly? We still don’t know.

Research does tell us that exercise plus education is probably the best thing you can do for your recovery.


Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.

Our goal? To make our own services redundant to you.

*We do not offer temporary pain relief such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.