Muscle Relaxants for Back Pain: Which to Use

Back Pain and Tendonitis — Can Muscle Relaxants Help?

Yes, they work — muscle relaxants are the primary class doctors prescribe for back pain and tendonitis caused by muscle tension, especially during the acute 5-7 day window.

Why do muscle relaxants help back pain?

Because most back pain does not come from bone — it comes from tense back muscles like the erector spinae along the spine, or quadratus lumborum at the lower back. When these muscles spasm, they send pain signals and restrict movement.

What should they be combined with for best effect?

The standard is muscle relaxant + analgesic / anti-inflammatory:

• Tolperisone/Eperisone + Paracetamol — for general pain without significant inflammation
• Tolperisone/Eperisone + NSAIDs (Ibuprofen, Naproxen, Celecoxib) — for inflammatory pain or tendonitis
• Norgesic alone — already contains Orphenadrine + Paracetamol in one tablet

📖 Read more: Complete muscle relaxant overview — mechanism, side effects — Muscle Relaxants — Complete Guide

Common Causes of Back Pain and Tendonitis

Back pain from daily life

• Prolonged screen work — trapezius and erector spinae tighten from poor posture
• Heavy lifting with bad form — acute back muscle injury
• Wrong pillow / mattress too firm or soft — wake up with stiff neck and aching back
• Improper exercise form — bad weightlifting technique causing muscle injury
• Stress — neck and shoulder muscles tense unconsciously

Common tendonitis cases

• Wrist tendonitis (De Quervain) — from phone use, typing, or frequent lifting
• Patellar tendonitis (knee) — athletes or runners
• Tennis/Golfer's elbow — from repetitive racquet/grip sports
• Achilles tendonitis — from running or unsupportive shoes

Deeper causes (require physician)

• Herniated disc compressing nerve — pain radiating to leg, numbness
• Spinal degeneration — chronic pain, age 50+
• Infection — pain with high fever
• Bone cancer (rare) — pain with weight loss, fatigue

Acute Back Pain — Which Muscle Relaxant to Choose

Drug selection by scenario

General back pain, can keep working → Mydocalm or Biocalm

Tolperisone minimal drowsiness, work as normal — first-line drug Thai doctors prescribe most. 50 mg three times daily after meals.

Need focus, driving → Myonal

Eperisone least sedating, suitable for office workers with back pain who still need to attend meetings, focus on work, or delivery drivers.

Severe pain, can rest → Norgesic before bed

Combined Orphenadrine + Paracetamol formula acts fast with immediate pain relief — but causes 6-8 hours drowsiness. Take before bed or on rest days.

Starting treatment

• Take immediately after meals for 5-7 days
• Apply heat compress to painful area 15-20 minutes, 2-3 times/day
• Avoid prolonged sitting — change posture every 30-45 minutes
• If no improvement within 5-7 days — see a doctor

💡 Read more: Which muscle relaxant brand suits you — Which Muscle Relaxant Brand is Best? — Comparison

Tendonitis — Which Drug Works Best

Can muscle relaxants help tendonitis?

Yes, in the early stage — muscle relaxants reduce tension in muscles surrounding the inflamed tendon, decreasing load and accelerating recovery. But the tendon inflammation itself requires NSAIDs alongside.

Standard regimen for tendonitis

• Tolperisone (Mydocalm/Biocalm) or Eperisone (Myonal) — relaxes muscles around the tendon
• + NSAID like Ibuprofen, Naproxen, Celecoxib — reduces tendon inflammation
• + Rest from the offending activity for 2-4 weeks
• + Cold compress 15-20 minutes 3-4 times/day for first 48 hours, then switch to warm

Chronic tendinopathy

If it persists beyond 4-6 weeks, medication alone is insufficient — must combine with physical therapy (eccentric exercise) and in some cases steroid injection or PRP from a specialist.

Myositis — Which Medication Helps

Myositis has several types — most common in daily life:

Traumatic myositis

From heavy exercise, heavy lifting, muscle tear/strain — muscle relaxant + NSAID is standard + muscle rest + cold compress for first 48 hours.

Post-exercise muscle soreness (DOMS)

Aches 24-72 hours after intense exercise — resolves on its own in 5-7 days. Supplement with Paracetamol or NSAID for pain; muscle relaxants help reduce tension.

Autoimmune myositis

Such as Polymyositis, Dermatomyositis — requires specialist physician. Steroids and immunosuppressants needed; general muscle relaxants insufficient.

Infectious myositis

Presents with high fever, red swelling — requires antibiotics. Do NOT self-medicate with muscle relaxants without seeing a doctor.

Chronic vs Acute Pain — Different Treatment

Acute pain

• Duration: less than 4 weeks
• Main cause: muscle tension, minor injury
• Treatment: muscle relaxant 5-7 days + NSAID/Paracetamol + compress + rest
• Prognosis: resolves within 1-2 weeks with proper care

Chronic pain

• Duration: over 12 weeks (3 months)
• Causes: herniated disc, spinal degeneration, neurological or psychological disorders
• Treatment: muscle relaxants are not primary — multimodal needed: physical therapy, nerve pain medications (Gabapentin, Pregabalin), sometimes surgery
• Warning: Do NOT take muscle relaxants continuously for months — see a doctor to find the cause

Subacute pain (4-12 weeks)

In between — muscle relaxants may be used intermittently under physician evaluation + combined physical therapy.

Drug Selection by Pain Type — Comparison Table

Non-Medication Therapies — Compress, Stretching, Massage, PT

Muscle relaxants work better combined with non-medication therapies:

🔥 Heat vs ❄️ Cold compress

• Cold compress for first 48 hours after injury — reduces swelling and inflammation, 15-20 minutes 3-4 times/day
• Warm compress after 48 hours — increases blood flow, relaxes muscles, 15-20 minutes 2-3 times/day

🧘 Gentle stretching

Start within 2-3 days of starting medication — back stretches: cat-cow, child's pose, knee-to-chest. Do NOT force if very painful.

💆 Light massage

Massage muscles around the painful area — do NOT massage directly on inflamed spots in the first 48 hours.

🏥 Physical therapy

For chronic pain or tendonitis — gold standard of treatment. Combines targeted exercise + ultrasound + electrical stimulation.

🚶 Walk frequently

Do NOT lie still all day — walk gently every 30-45 minutes, helps muscles stay loose and recover faster.

💧 Hydration + sleep

Dehydration causes cramps — drink 2-3 liters/day, sleep 7-9 hours for muscle repair.

When Back Pain Needs a Doctor — Warning Signs

Most back pain resolves on its own, but some signs must NOT wait — see a doctor immediately:

• ❗ Pain radiating to leg, leg numbness — suspect herniated disc compressing nerve
• ❗ Leg weakness, unable to walk — sign of severe nerve compression
• ❗ Loss of bladder/bowel control — Cauda equina syndrome, requires urgent surgery
• ❗ High fever with back pain — suspect infection (vertebral osteomyelitis)
• ❗ Unexplained weight loss + chronic pain — must rule out serious disease
• ❗ Severe night pain — especially pain that wakes you
• ❗ Pain persisting beyond 2 weeks despite full medication course
• ❗ History of cancer + new back pain
• ❗ Recent fall or trauma before pain started

If 1 or more apply → go to ER or orthopedic clinic immediately.

Preventing Chronic Back Pain From Returning

Adjust work posture

• Straight back, chair supports lower back
• Monitor at eye level, no neck bending
• Feet flat on floor, no leg crossing
• Change posture every 30-45 minutes

Strengthen core muscles

Plank, Bird-dog, Dead bug — 3-4 times/week supports the spine and reduces recurrence.

Lift correctly

Squat down, straight back, push with legs not back — get help for very heavy items.

Mattress + pillow care

Medium-firm mattress, neither too soft nor too hard. Neck pillow keeps spine alignment.

Manage stress

Stress causes muscle tension — practice deep breathing, meditate 10-15 minutes/day.

Maintain healthy weight

Excess weight increases spinal load — keep BMI in normal range to reduce chronic back pain risk.