Medication For Persistent Pain: Antispasmodic Medications

What are Antispasmodic Medications?

Antispasmodic medications are drugs that help relieve or prevent muscle spasms, especially in smooth muscles like those found in the digestive tract, urinary system, and other organs. These medications are used to reduce muscle cramps, spasms, or tension by either acting on the nervous system or directly relaxing the muscles.

These medications are generally well-tolerated, but some can cause side effects like dry mouth, blurred vision, constipation, or dizziness, especially with the anticholinergic types. They are often used as part of a broader treatment plan, including diet and lifestyle changes, depending on the condition.

What is Orphenadrine?

Orphenadrine is a muscle relaxant and anticholinergic drug available in oral form and by injection that is primarily used to treat muscle pain, muscle spasms, and related discomfort. It is chemically related to diphenhydramine (an antihistamine) and works by blocking acetylcholine, a neurotransmitter that influences muscle contractions.

By doing so, Orphenadrine helps reduce muscle stiffness and discomfort without directly affecting muscle function.

Some conditions treated by Orphenadrine include:

• Muscle Strains and Sprains. Orphenadrine helps reduce pain and muscle stiffness in acute injuries like muscle strains or sprains.
• Back Pain. It is frequently used for short-term relief of lower back pain caused by muscle spasms.
• Tension Headaches. Orphenadrine can sometimes be used to relieve the muscle tension that contributes to certain types of headaches.
• Musculoskeletal Pain. It is prescribed for various conditions causing acute musculoskeletal pain and discomfort.

What is Baclofen?

Baclofen is a muscle relaxant and antispasmodic medication used to treat muscle spasms, pain, and stiffness, particularly in conditions that affect the central nervous system. It works by acting on the spinal cord to suppress the transmission of nerve signals that lead to muscle contractions.This leads to a reduction in muscle spasticity (involuntary muscle tightness or contractions) without affecting muscle strength.

It is commonly available in oral form, but in severe cases of spasticity, a pump may be surgically implanted to deliver baclofen directly into the spinal fluid, providing more targeted relief with lower doses and fewer side effects. Baclofen treats a range of conditions, including:

• Multiple Sclerosis (MS). Baclofen helps relieve spasticity, muscle stiffness, and spasms commonly associated with MS.
• Spinal Cord Injuries. It reduces spasticity in patients who have sustained damage to the spinal cord.
• Cerebral Palsy. Baclofen can be used to manage spasticity in children and adults with cerebral palsy.
• Stroke or Brain Injury. Baclofen may help with spasticity following a stroke or other traumatic brain injury.
• Amyotrophic Lateral Sclerosis (ALS). It is sometimes used in managing muscle symptoms in ALS patients.

What do Antispasmodic Medications Treat?

Antispasmodic medications like baclofen and orphenadrine are primarily used to treat conditions that involve muscle spasms, spasticity, and related discomfort. These medications work by reducing or preventing involuntary muscle contractions and easing muscle tension.

Both baclofen and orphenadrine are effective at relieving muscle symptoms, but they are used for different types of conditions. Baclofen focuses on spasticity due to neurological issues, while orphenadrine is typically prescribed for acute musculoskeletal pain.

How do Antispasmodic Medications Alleviate Chronic Pain?

Antispasmodic medications alleviate chronic pain by targeting and reducing muscle spasms, tension, or involuntary contractions that often contribute to or worsen chronic pain conditions. These medications work on different mechanisms to relax muscles, relieve spasms, and reduce the pain associated with them. Here is how they help:

Muscle Relaxation

Chronic pain often involves muscle tension or spasms that result from injury, inflammation, or underlying neurological conditions. Antispasmodic medications work by relaxing the muscles, either by acting on the central nervous system or directly on muscle fibres.

Baclofen, for example, reduces the excessive nerve signals that cause muscle spasms. By activating GABA-B receptors in the spinal cord, it decreases the excitatory signals that lead to muscle stiffness and tightness, providing relief in conditions like multiple sclerosis (MS) or spinal cord injuries.

Orphenadrine, on the other hand, relaxes muscles through its anticholinergic action, blocking the nerve signals that cause spasms and muscle contractions in musculoskeletal pain conditions.

Reducing Neurological Overactivity

In conditions where the nervous system is overactive, such as spasticity in multiple sclerosis or cerebral palsy, antispasmodics help calm overactive nerve signalling. This overactivity can cause persistent muscle contractions that lead to pain.

Interrupting the Pain-Spasm-Pain Cycle

Chronic pain often results in a pain-spasm-pain cycle, where pain causes muscle spasms, which then exacerbate the pain, creating a vicious cycle. Antispasmodic medications break this cycle by relaxing the muscles, which reduces the spasms and, in turn, lowers the perception of pain.

Improving Mobility and Function

Chronic pain can severely limit mobility, especially when it is related to spasticity or muscle tightness. By reducing spasms and muscle tension, antispasmodics improve range of motion and physical function, allowing individuals to move more freely with less pain. This improvement in mobility often reduces the pain caused by immobility-related muscle stiffness or contractures.

Reducing Pain-Related Inflammation

In conditions where inflammation plays a role in chronic pain, such as fibromyalgia or myofascial pain syndrome, muscle spasms can further aggravate the affected areas. Antispasmodic medications reduce these spasms, helping to decrease the localised irritation and inflammation that contribute to pain.

Why Would You Take Antispasmodic Medications like Orpenadrine or Baclofen for Chronic Pain?

Taking antispasmodic medications like orphenadrine or baclofen for chronic pain can provide significant relief when chronic pain is related to muscle spasms, spasticity, or tension. These medications help by addressing the underlying muscle issues that contribute to persistent pain.

Relief from Muscle Spasms and Tension

Chronic pain, especially in conditions like back pain, fibromyalgia, or spinal cord injuries, often involves muscle spasms or stiffness that worsen the pain. Antispasmodic medications like orphenadrine and baclofen target these muscle issues by relaxing the muscles and reducing spasms

Breaking the Pain-Spasm Cycle

In chronic pain conditions, a pain-spasm-pain cycle can develop. This means pain causes muscle spasms, and those spasms then make the pain worse, perpetuating the cycle.

Antispasmodics break this cycle by relaxing the muscles, which reduces spasms and eases tension, lowering the overall level of pain.

By breaking this cycle, the medications help manage chronic pain more effectively, allowing the muscles to relax and preventing further aggravation of pain-sensitive areas.

Improving Mobility and Function

Chronic pain, especially when related to muscle tension or spasticity, can severely restrict mobility and make daily activities difficult or painful. Antispasmodics like baclofen and orphenadrine help improve range of motion by reducing muscle stiffness, allowing for greater flexibility and ease of movement.

For individuals with conditions like spinal cord injuries or multiple sclerosis, baclofen’s ability to reduce spasticity can make it easier to move and perform daily activities, which can in turn help manage pain.

In cases of chronic back or neck pain, orphenadrine can relieve the muscle tension that limits mobility, providing relief from both pain and stiffness.

Targeting the Neurological Source of Pain

In conditions like multiple sclerosis, cerebral palsy, or spinal cord injuries, chronic pain often results from neurological issues that cause abnormal muscle contractions (spasticity).

For instance, Baclofen works by acting on the central nervous system, specifically targeting the GABA-B receptors in the spinal cord. This reduces overactive nerve signalling that causes spasticity, allowing the muscles to relax and reducing pain caused by those muscle contractions.

Baclofen’s action in calming neurological overactivity makes it especially useful for pain caused by nerve-related muscle stiffness, which wouldn’t respond to typical painkillers.

Reducing Pain in Neuromuscular and Musculoskeletal Conditions

For conditions that involve both nerve and muscle components, like fibromyalgia or myofascial pain syndrome, antispasmodics can help manage chronic pain by relaxing the affected muscles and reducing the irritation that contributes to pain.

Orphenadrine is particularly useful in conditions where muscle overuse or injury leads to ongoing spasms that exacerbate pain, while Baclofen is helpful in cases where spasticity (sustained muscle stiffness) causes significant pain, as it directly targets the neurological source of the problem.

Adjunct to Other Pain Management Approaches

Antispasmodic medications are often used alongside other forms of pain management, such as physical therapy, anti-inflammatory drugs, or opioid medications.

In chronic pain treatment plans, antispasmodics can provide targeted relief for muscle-related pain without relying solely on opioids or stronger painkillers. They also improve the effectiveness of physical therapy by reducing muscle tension and making it easier to stretch or exercise affected muscles.

Risks of Antispasmodic Medications

Antispasmodic medications, while effective in relieving muscle spasms and pain, come with certain risks and potential side effects. These risks can vary depending on the specific medication (e.g., baclofen, orphenadrine), dosage, duration of use, and the individual’s overall health.

Some risks associated with antispasmodic medications:

Drowsiness and Fatigue

Many antispasmodics, particularly those that act on the central nervous system (like baclofen), can cause drowsiness and fatigue as common side effects. This can impact daily functioning, making activities such as driving, operating machinery, or performing tasks that require focus more dangerous.

Dizziness and Lightheadedness

These medications may cause dizziness, especially when changing positions (from sitting to standing). This increases the risk of falls or accidents, particularly in older adults or those with balance issues.

Sedation and Cognitive Impairment

Both baclofen and orphenadrine can cause sedation and cognitive impairment, such as difficulty concentrating, memory problems, or confusion. These effects are more pronounced when taking higher doses or combining the medications with other CNS depressants like alcohol, benzodiazepines, or opioids.

Anticholinergic Effects

Medications like orphenadrine, which have anticholinergic properties, can cause dry mouth, blurred vision, urinary retention, constipation, and increased heart rate.

These side effects are particularly concerning for older adults, as they can lead to further complications such as dehydration, urinary tract infections, or exacerbation of glaucoma.

Dependence and Withdrawal Symptoms

Some antispasmodics, particularly baclofen, can cause physical dependence if used long-term. Suddenly stopping the medication after prolonged use can lead to withdrawal symptoms, including rebound spasticity (worsening of spasms), hallucinations, seizures, and delirium.

For this reason, baclofen should always be tapered off gradually under medical supervision if discontinuation is needed.

Hypotension (Low Blood Pressure)

Baclofen, due to its effects on the central nervous system, may cause low blood pressure (hypotension), which can lead to lightheadedness or fainting. This can be dangerous, particularly for people with cardiovascular conditions or those on other medications that lower blood pressure.

Gastrointestinal Issues

Some antispasmodics can cause nausea, vomiting, or constipation. These side effects are more common with oral medications like baclofen and orphenadrine, and can exacerbate pre-existing gastrointestinal problems.

Weakness or Muscle Fatigue

While these medications are designed to reduce muscle spasms, they can sometimes cause excessive muscle relaxation or weakness, especially at higher doses. This can be problematic for individuals who require some level of muscle strength for mobility or physical therapy.

Allergic Reactions

Though rare, some people may experience allergic reactions to antispasmodic medications, which can manifest as rashes, itching, swelling of the face or tongue, or difficulty breathing, all of which require immediate medical attention.

Additive CNS Depression

Combining antispasmodics like baclofen or orphenadrine with other CNS depressants (e.g., alcohol, sedatives, opioids, or sleep aids) can increase the risk of excessive sedation or respiratory depression.

Risk of Overdose

Taking higher than prescribed doses of antispasmodics can result in an overdose, which can lead to severe drowsiness, confusion, seizures, respiratory depression, and in the case of baclofen, coma or other life-threatening complications, especially in children or people with compromised liver or kidney function.

Psychiatric Symptoms

Baclofen, particularly in higher doses, has been associated with psychiatric side effects such as mood swings, depression, hallucinations, and anxiety.

These effects are more likely to occur in individuals with a history of psychiatric disorders or those taking other medications that affect mood.

Contraindications and Pre-existing Conditions

Certain health conditions may increase the risk of complications when taking antispasmodics. For example, anticholinergic drugs like orphenadrine can exacerbate glaucoma.

Baclofen is processed through the kidneys, and any dysfunction can increase the risk of toxicity. Orphenadrine’s metabolism can also be impaired in those with liver conditions.

Orphenadrine can cause urinary retention, which may be problematic in men with an enlarged prostate.

Tachycardia or Palpitations

Orphenadrine, due to its anticholinergic effects, can sometimes cause increased heart rate or palpitations, particularly in individuals with underlying heart conditions. This can increase the risk of cardiovascular events in some patients.

Finding a Persistent Pain Doctor Near You

If you are suffering from muscle spasms and related chronic pain, an antispasmodic medication(s) regimen may work for you.

To find a doctor near you who treats persistent or chronic pain, ask your general practitioner for a referral to a pain management physician.

Also, you can research pain management clinics online or speak to family members, friends, or support groups (both online and in real life) for recommendations; those who have dealt with similar chronic pain issues or other problems may have valuable advice to offer.

Antispasmodic drugs can alleviate some types of pain, providing a higher quality of life for patients dealing with chronic pain conditions that have not responded well to other treatments.