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.
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References
Reginster JY. The prevalence and burden of arthritis. Rheumatology. 2002;41 (suppl. 1):3–6.
Jackson KC 2nd. Pharmacotherapy in lower back pain. Drugs Today (Barc). 2004;40:765–772.
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.
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.
Raspe H. Management of chronic low back pain in 2007–2008. Curr Opin Rheumatol. 2008;20:276–281.
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.
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.
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.
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.
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.
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.
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.
Schnitzer TJ, Gray WL, Paster RZ, Kamin M. Efficacy of tramadol in treatment of chronic low back pain. J Rheumatol. 2000;27:772–778.
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.
Elenbaas JK. Centrally acting oral skeletal muscle relaxants. Am J Hosp Pharm. 1980;37:1313–1323.
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.
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.
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.
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.
Farkas S. Silperisone: a centrally acting muscle relaxant. CNS Drug Rev. 2006;12:218–235.
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.
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.
Murayama K, Katsumi T, Tajika E, Nakamura T. Clinical application of eperisone hydrochloride to neurogenic bladder. Hinyokika Kiyo. 1984;30:403–408.
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.
Weinblatt ME. Nonsteroidal antiinflammatory drug toxicity: increased risk in the elderly. Scand J Rheumatol Suppl. 1991;91:9–17.
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.
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.
Snapinn SM. Evaluating the efficacy of a combination therapy. Stat Med. 1987;6:657–665.
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.
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.
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.
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.
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.
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.
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.
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.
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Sartini, S., Guerra, L. Open experience with a new myorelaxant agent for low back pain. Adv Therapy 25, 1010–1018 (2008). https://doi.org/10.1007/s12325-008-0108-9
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DOI: https://doi.org/10.1007/s12325-008-0108-9