What is the strongest muscle relaxer?

“I've been having intense back pain when I get up or sit down. What is the strongest muscle relaxer a doctor can prescribe to treat this pain?”

Dr. Janessa Oliveira
Biochemist and Pharmacist CRF-SP 22143

Some of the strongest muscle relaxers that an orthopedic doctor may prescribe for conditions such as back pain, stiff neck, or fibromyalgia include:

1. Carisoprodol combinations

  • Torsilax and Mioflex A: contain the muscle relaxer carisoprodol, along with the anti-inflammatory/analgesics diclofenac sodium and acetaminophen, plus caffeine.
    Note: These specific combinations are not FDA-approved. In the US, carisoprodol is available under the brand name Soma.

2. Orphenadrine combinations

  • Dorflex: contains the muscle relaxer orphenadrine citrate, together with dipyrone and caffeine.
    Note: Dipyrone is not FDA-approved in the US. Orphenadrine is available under brand names such as Norflex.

3. Chlorzoxazone combinations

  • Parafon Forte: contains the muscle relaxer chlorzoxazone combined with acetaminophen.
    Note: In the US, chlorzoxazone is available under names like Parafon Forte DSC, but it is not usually combined with acetaminophen.

4. Cyclobenzaprine

  • Cyclobenzaprine hydrochloride (known in Brazil as Mirtax): helps relieve pain, muscle tenderness, and restricted movement linked to acute muscle spasms.
    In the US, cyclobenzaprine is widely available under brand names like Flexeril or as a generic.

These medicines are not effective for conditions such as multiple sclerosis, amyotrophic lateral sclerosis (ALS), brain-related spasms, infectious or degenerative diseases, tumors, spinal cord injury or compression, or cerebral palsy. In these cases, a doctor may prescribe other muscle relaxers such as baclofen or tizanidine hydrochloride.

5. Diazepam

Diazepam may also be used as a muscle relaxer to ease involuntary muscle contractions. It can be prescribed for situations involving trauma, inflammation, cerebral palsy, or paraplegia.

All of these medications should only be used under the guidance of an orthopedic specialist or a general practitioner.

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