In another front in the quest to find effective nonopioid pain management strategies, Childers and associates[10] have found that low doses of cyclobenzaprine, a muscle relaxant related to the tricyclic class of antidepressants, when given as monotherapy, is as effective as cyclobenzaprine and ibuprofen combined. In addition, the low dose — 5 mg 3 times daily — is as effective as a higher dose used in other research with cyclobenzaprine — 10 mg 3 times daily. In this 7-day study, Childers and colleagues randomized 867 patients with acute muscle spasm of the back or neck to 5 mg of cyclobenzaprine 3 times daily or 400 mg or 800 mg of ibuprofen. All 3 treatment groups had a significant improvement over baseline (P < .001). The findings led the investigators to conclude that for musculoskeletal pain with a spasmodic component, cyclobenzaprine monotherapy, even at a low dose, is as effective as combination therapy with ibuprofen, a finding that broadens the options for patients who cannot take ibuprofen.

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