Skeletal Muscle Relaxants for the Treatment of Myofascial Pelvic Pain and High Tone Pelvic Floor Disorders in Women: A Scoping Review

Abstract

Study Objective To review the evidence of muscle relaxants and non-injectable drugs with muscle relaxant properties for the treatment of chronic pelvic pain. This includes investigation of whether the concept of skeletal muscle relaxant use for lower back striated muscle strain is a valid construct to apply to the context and treatment of women with chronic pelvic pain due to myofascial and hypertonic muscular dysfunction. The clinical effectiveness, side effects, and toxicology risk of the investigated drugs were characterized. Design A scoping review was conducted in accordance with PRISMA-ScR guidelines and protocols. Online databases were searched using MeSH and subject terms. Articles reporting evidence on skeletal muscle relaxant use were reviewed by two independent reviewers with a third reviewer for any discrepancies. Setting Scoping review. Patients or Participants N/A. Interventions N/A. Measurements and Main Results Comparison studies have not shown any skeletal muscle relaxant to be superior. Skeletal muscle relaxants are divided into two categories: antispastic and antispasmodic agents. Antispastic agents reduce muscle hypertonicity and involuntary jerks associated with neurological disorders. Antispasmodic agents aim to treat striated muscle spasms from musculoskeletal conditions such as low back pain and myofascial pain. Cyclobenzaprine is heavily studied, with demonstrated effectiveness for isolated conditions. Intravaginal diazepam may be beneficial, while other drugs have limited investigation. Considerable knowledge gaps remain regarding appropriate use of these medications in the context of pelvic pain. Conclusion Scant high-quality data exist to support the use of skeletal muscle relaxants for chronic pelvic pain secondary to myofascial and hypertonic muscular dysfunction. Antispastic agents have limited evidence. Antispasmodic agent usage should be based on side-effect profile, patient preference, abuse potential, and possible drug interactions. Future prospective research on antispasmodic agents in women with myofascial dysfunction is necessary to define medication safety, route, dosage, and clinical outcomes. To review the evidence of muscle relaxants and non-injectable drugs with muscle relaxant properties for the treatment of chronic pelvic pain. This includes investigation of whether the concept of skeletal muscle relaxant use for lower back striated muscle strain is a valid construct to apply to the context and treatment of women with chronic pelvic pain due to myofascial and hypertonic muscular dysfunction. The clinical effectiveness, side effects, and toxicology risk of the investigated drugs were characterized. A scoping review was conducted in accordance with PRISMA-ScR guidelines and protocols. Online databases were searched using MeSH and subject terms. Articles reporting evidence on skeletal muscle relaxant use were reviewed by two independent reviewers with a third reviewer for any discrepancies. Scoping review. N/A. N/A. Comparison studies have not shown any skeletal muscle relaxant to be superior. Skeletal muscle relaxants are divided into two categories: antispastic and antispasmodic agents. Antispastic agents reduce muscle hypertonicity and involuntary jerks associated with neurological disorders. Antispasmodic agents aim to treat striated muscle spasms from musculoskeletal conditions such as low back pain and myofascial pain. Cyclobenzaprine is heavily studied, with demonstrated effectiveness for isolated conditions. Intravaginal diazepam may be beneficial, while other drugs have limited investigation. Considerable knowledge gaps remain regarding appropriate use of these medications in the context of pelvic pain. Scant high-quality data exist to support the use of skeletal muscle relaxants for chronic pelvic pain secondary to myofascial and hypertonic muscular dysfunction. Antispastic agents have limited evidence. Antispasmodic agent usage should be based on side-effect profile, patient preference, abuse potential, and possible drug interactions. Future prospective research on antispasmodic agents in women with myofascial dysfunction is necessary to define medication safety, route, dosage, and clinical outcomes.