Advances in Therapy

, Volume 25, Issue 10, pp 1010–1018 | Cite as

Open experience with a new myorelaxant agent for low back pain

  • Silvana Sartini
  • Lucia Guerra
Original Research

Abstract

Introduction

Eperisone hydrochloride has been recently proposed as a muscle relaxant for the treatment of muscle contracture and chronic low back pain (LBP) as it is devoid of clinically relevant sedative effects on the central nervous system (CNS). We tested this hypothesis by performing a study of patients with LBP and muscle contracture who were treated with full-dose eperisone.

Methods

Patients with moderate to severe, acute, or relapsing LBP received eperisone 100 mg three times daily for 10 consecutive days. Assessments included: spontaneous pain, pain on movement, resistance to passive movement, antalgic rigidity, and tolerability.

Results

In total, 100 patients were enrolled into the study. The treatment achieved a consistent analgesic and muscle relaxant activity across all patients. Both spontaneous pain and pain on movement were significantly decreased, as was resistance encountered by the investigator to passive movements, antalgic rigidity, and muscle contracture. As a consequence, treatment with eperisone resulted in a lower rigidity of the lower back and an improved motility for patients.

Only seven adverse reactions were reported, including light-headedness (1), occasional vertigo and/or loss of equilibrium (3), mild somnolence (2), and epigastric pain (1). In almost all cases, there was no need to interrupt the treatment and the adverse reaction resolved spontaneously.

Conclusions

Eperisone had an analgesic and muscle relaxant effect in patients with LBP. It should be noted that while it is common practice in rheumatology to combine a pain killer with a muscle relaxant in order to achieve a satisfactory result on both symptoms, the present results with eperisone were achieved with a single drug. With an improved tolerability profile compared with nonsteroidal anti-inflammatory drugs, and a lack of significant adverse effects on the CNS, eperisone hydrochloride represents a valuable alternative to traditional analgesics and muscle relaxants for the treatment of LBP.

Keywords

analgesic eperisone hydrochloride low back pain muscle relaxant 

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References

  1. 1.
    Reginster JY. The prevalence and burden of arthritis. Rheumatology. 2002;41 (suppl. 1):3–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Jackson KC 2nd. Pharmacotherapy in lower back pain. Drugs Today (Barc). 2004;40:765–772.CrossRefGoogle Scholar
  3. 3.
    Centers for Disease Control. Prevalence of disabilities and associated health conditions among adults-United States, 1999. MMWR Morb Mortal Wkly Rep. 2001;50:120–125.Google Scholar
  4. 4.
    Cherry DK, Woodwell DA. National Ambulatory Medical Care Survey: 2000 Summary. Advance Data Vital and Health Statistics; No. 328. Hyattsville, MD: National Center for Health Statistics; 2002.Google Scholar
  5. 5.
    Raspe H. Management of chronic low back pain in 2007–2008. Curr Opin Rheumatol. 2008;20:276–281.PubMedCrossRefGoogle Scholar
  6. 6.
    Hernandez-Diaz S, Garcia Rodriguez LA. Epidemiological assessment of the safety of conventional nonsteroidal anti-inflammatory drugs. Am J Med. 2001;110(suppl. 3A):20S–27S.PubMedCrossRefGoogle Scholar
  7. 7.
    Garcia Rodriguez LA, Hernandez-Diaz S. The epidemiology of myocardial infarction and heart failure among users of nonsteroidal antiinflammatory drugs. Epidemiology. 2000;11:382–386.PubMedCrossRefGoogle Scholar
  8. 8.
    Nielsen GL, Sorensen HT, Larsen H, Pedersen L. Risk of adverse birth outcome and miscarriage in pregnant users of non-steroidal antiinflammatory drugs: population-based observational study and case-control study. Brit Med J. 2001;322:266–270.PubMedCrossRefGoogle Scholar
  9. 9.
    Garcia Rodriguez LA, Hernandez-Diaz S. Relative risk of upper gastrointestinal complications among users of acetaminophen and nonsteroidal antiinflammatory drugs. Epidemiology. 2001;12:570–576.PubMedCrossRefGoogle Scholar
  10. 10.
    Hale ME, Dvergsten C, Gimbel J. Efficacy and safety of oxymorphone extended release in chronic low back pain: results of a randomized, double-blind, placebo-and active-controlled phase III study. J Pain. 2005;6:21–28.PubMedCrossRefGoogle Scholar
  11. 11.
    Hale ME, Fleischmann R, Salzman R, et al. Efficacy and safety of controlled-release versus immediate-release oxycodone: randomized, double-blind evaluation in patients with chronic back pain. Clin J Pain. 1999;15:179–183.PubMedCrossRefGoogle Scholar
  12. 12.
    Salzman RT, Roberts MS, Wild J, Fabian C, Reder RF, Goldenheim PD. Can a controlled-release oral dose form of oxycodone be used as readily as an immediate-release form for the purpose of titrating to stable pain control? J Pain Symptom Manage. 1999;18:271–279.PubMedCrossRefGoogle Scholar
  13. 13.
    Schnitzer TJ, Gray WL, Paster RZ, Kamin M. Efficacy of tramadol in treatment of chronic low back pain. J Rheumatol. 2000;27:772–778.PubMedGoogle Scholar
  14. 14.
    Ruoff GE, Rosenthal N, Jordan D, Karim R, Kamin M. Tramadol/acetaminophen combination tablets for the treatment of chronic lower back pain: a multicenter, randomized, double-blind, placebocontrolled outpatient study. Clin Ther. 2003;25:1123–1141.PubMedCrossRefGoogle Scholar
  15. 15.
    Elenbaas JK. Centrally acting oral skeletal muscle relaxants. Am J Hosp Pharm. 1980;37:1313–1323.PubMedGoogle Scholar
  16. 16.
    Morikawa K, Oshita M, Yamazaki M, et al. Pharmacological studies of the new centrally acting muscle relaxant 4′-ethyl-2-methyl-3-pyrrolidinopropiophenone hydrochloride. Arzneimittelforschung. 1987;37:331–336.PubMedGoogle Scholar
  17. 17.
    Matsunaga M, Uemura Y, Yonemoto Y, et al. Long-lasting muscle relaxant activity of eperisone hydrochloride after percutaneous administration in rats. Jpn J Pharmacol. 1997;73:215–220.PubMedCrossRefGoogle Scholar
  18. 18.
    Iwase S, Mano T, Saito M, Ishida G. Effect of a centrally-acting muscle relaxant, eperisone hydrochloride, on muscle sympathetic nerve activity in humans. Funct Neurol. 1992;7:459–470.PubMedGoogle Scholar
  19. 19.
    Sakaue A, Honda M, Tanabe M, Ono H. Antinociceptive effects of sodium channel-blocking agents on acute pain in mice. J Pharmacol Sci. 2004;95:181–188.PubMedCrossRefGoogle Scholar
  20. 20.
    Farkas S. Silperisone: a centrally acting muscle relaxant. CNS Drug Rev. 2006;12:218–235.PubMedCrossRefGoogle Scholar
  21. 21.
    Kocsis P, Farkas S, Fodor L, et al. Tolperisone-type drugs inhibit spinal reflexes via blockade of voltage-gated sodium and calcium channels. J Pharmacol Exp Ther. 2005;315:1237–1246.PubMedCrossRefGoogle Scholar
  22. 22.
    Nakagawa M, Nakahara K, Maruyama Y, et al. Therapeutic trials in 200 patients with HTLV-I-associated myelopathy/tropical spastic paraparesis. J Neurovirol. 1996;2:345–355.PubMedCrossRefGoogle Scholar
  23. 23.
    Murayama K, Katsumi T, Tajika E, Nakamura T. Clinical application of eperisone hydrochloride to neurogenic bladder. Hinyokika Kiyo. 1984;30:403–408.PubMedGoogle Scholar
  24. 24.
    Kobayashi Y, Kawasaki T, Yoshimi T, Nakajima T, Kanai K. Muscle cramps in chronic liver diseases and treatment with antispastic agent (eperisone hydrochloride). Dig Dis Sci. 1992;37:1145–1146.PubMedCrossRefGoogle Scholar
  25. 25.
    Weinblatt ME. Nonsteroidal antiinflammatory drug toxicity: increased risk in the elderly. Scand J Rheumatol Suppl. 1991;91:9–17.PubMedCrossRefGoogle Scholar
  26. 26.
    Bose K. The efficacy and safety of eperisone in patients with cervical spondylosis: results of a randomized, double-blind, placebocontrolled trial. Methods Find Exp Clin Pharmacol. 1999;21:209–213.PubMedCrossRefGoogle Scholar
  27. 27.
    Tariq M, Akhtar N, Ali M, Rao S, Badshah M, Irshad M. Eperisone compared to physiotherapy on muscular tone of stroke patients: a prospective randomized open study. J Pak Med Assoc. 2005;55:202–204.PubMedGoogle Scholar
  28. 28.
    Snapinn SM. Evaluating the efficacy of a combination therapy. Stat Med. 1987;6:657–665.PubMedCrossRefGoogle Scholar
  29. 29.
    Borenstein DG, Lacks S, Wiesel SW. Cyclobenzaprine and naproxen versus naproxen alone in the treatment of acute low back pain and muscle spasm. Clin Ther. 1990;12:125–131.PubMedGoogle Scholar
  30. 30.
    Graven-Nielsen T, Jansson Y, Segerdahl M, et al. Experimental pain by ischaemic contractions compared with pain by intramuscular infusions of adenosine and hypertonic saline. Eur J Pain. 2003;7:93–102.PubMedCrossRefGoogle Scholar
  31. 31.
    Yabuki S, Kikuchi S, Midorikawa H, Hoshino S. Vascular backache and consideration of its pathomechanisms: report of two cases. J Spinal Disord. 1999;12:162–167.PubMedCrossRefGoogle Scholar
  32. 32.
    Inoue S, Bian K, Okamura T, Okunishi H, Toda N. Mechanisms of action of eperisone on isolated dog saphenous arteries and veins. Jpn J Pharmacol. 1989;50:271–282.PubMedCrossRefGoogle Scholar
  33. 33.
    Juni P, Nartey L, Reichenback S, Sterchi R, Dieppe PA, Egger M. Risk of cardiovascular events and rofecoxib: cumulative metaanalysis. Lancet. 2004;364:2021–2029.PubMedCrossRefGoogle Scholar
  34. 34.
    van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Cochrane Back Review Group. Muscle relaxants for nonspecific low back pain: a systematic review within the framework of the Cochrane collaboration. Spine. 2003;28:1978–1992.PubMedCrossRefGoogle Scholar
  35. 35.
    Chou R, Huffman LH. American Pain Society. American College of Physicians. Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147:505–514.PubMedGoogle Scholar
  36. 36.
    Toth PP, Urtis J. Commonly used muscle relaxant therapies for acute low back pain: a review of carisoprodol, cyclobenzaprine hydrochloride, and metaxalone. Clin Ther. 2004;26:1355–1367.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Healthcare Communications 2008

Authors and Affiliations

  • Silvana Sartini
    • 1
  • Lucia Guerra
    • 2
  1. 1.Service of Rehabilitation and Functional ReeducationS. Orsola-Malpighi HospitalBolognaItaly
  2. 2.Medical Service Alfa WassermannBolognaItaly

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