Evidence map›Paper›PMID 40186696›Full record

SynthesisEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2025

Oral non-benzodiazepine muscle-relaxants for people with acute and chronic primary low back pain: a systematic review with meta-analysis.

Andrea Manca, Lucia Cugusi, Maurits van Tulder, Andrea Furlan, Federico Solla, Marco Monticone

Abstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Andrea MancaDepartment of Biomedical Sciences, University of Sassari, Sassari, Italy. andmanca@uniss.it.
Lucia CugusiDepartment of Biomedical Sciences, University of Sassari, Sassari, Italy.
Maurits van TulderDepartment of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, Netherlands.
Andrea FurlanDepartment of Medicine, University of Toronto, Toronto, ON, Canada.
Federico SollaSurgery Unit, Lenval University Childrens Hospital, Nice, France.
Marco MonticoneDepartment of Surgical Sciences, University of Cagliari, Cagliari, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo determine benefits and adverse effects (AE) of oral muscle-relaxants (MR) (non-benzodiazepines) for acute (< 6 weeks) and chronic (> 12 weeks) primary LBP, administered alone or combined with analgesics/NSAIDs.

methodsCENTRAL, MEDLINE, EMBASE, CINAHL were searched for pertinent randomized controlled trials. Primary outcomes comprised lack of pain relief, global efficacy and AE at 5-7 days follow-up assessed dichotomously (risk ratio, RR).

resultsFifty studies (7531 participants) were included, with data from 4775 pooled in meta-analyses. For acute LBP, non-benzodiazepine MR were associated with increased likelihood of pain relief (moderate certainty; RR: 0.53, p < 0.0001), global efficacy (RR: 0.49, p = 0.0001), muscle spasm (RR: 0.62, p < 0.00001), and physical outcomes (RR: 0.60, p < 0.00001) compared to placebo. AE were more frequent with non-benzodiazepine MR compared to placebo (low-to-moderate certainty; RR: 1.56; p = 0.003), and at central nervous system (CNS; RR: 2.40; p < 0.00001), but not at gastrointestinal (GI) level (RR: 0.77; p = 0.62). Combined non-benzodiazepines + analgesics/non-steroidal anti-inflammatory drugs (NSAIDs) provide a larger and clinically meaningful benefit compared to placebo + analgesics/NSAIDs for global efficacy at 5-7 days (low-certainty; RR: 0.62; p = 0.01). Combined therapy did not result in significant between-group differences for total AE (moderate-certainty; RR: 1.15; p = 0.50) and GI AE (RR: 0.63; p = 0.08), despite responsible for more CNS AE (low-certainty; RR: 1.91; p = 0.002). When comparing non-benzodiazepine MR versus placebo for chronic LBP, only data on total AE could be pooled, without between-group difference (RR: 0.93; p = 0.69).

conclusionsNon-benzodiazepine MR for acute LBP were associated with increased likelihood of pain relief and global efficacy compared to placebo. Combined therapy with analgesics/NSAIDs proved superior for global efficacy. Studies are needed to evaluate if non-benzodiazepine MR are of larger benefit than analgesics/NSAIDs, and if stand-alone administration provides more benefit than combined treatment. The observed AE warrant caution.

Indexed as

Acute PainChronic PainLow Back PainNeuromuscular AgentsAdministration, OralHumansRandomized Controlled Trials as TopicNeuromuscular AgentsLow back painMuscle-relaxantsNon-benzodiazepinePlacebo

Identifiers

PMID40186696

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.