How Compound Cyclobenzaprine Can Help Ease the Discomfort of Myofascial Pain Syndrome
Not all active pharmaceutical ingredients are created equal. Sometimes an API will be so versatile and effective that it can be used to address patients’ painful conditions in many ways, as an injectable medication and as a topical pain management analgesic. For sufferers of myofascial pain syndrome (MPS), that double threat compound is cyclobenzaprine.
For many patients who experience muscle spasms, cyclobenzaprine is a very familiar first-line treatment. As long as the patient has not taken a monoamine oxidase inhibitor in the two weeks leading up to their treatment, cyclobenzaprine is often prescribed as a muscle relaxant for acute musculoskeletal conditions and has also been studied in recent years for management of chronic fibromyalgia-related pain. For myofascial pain syndrome, cyclobenzaprine can be used in its traditional format and injected, or, in the hands of a compounding pharmacist, it can be compounded into a topical to address muscle pain associated with MPS.
Trigger Point Injection with Cyclobenzaprine Soothes the Pain
Myofascial pain syndrome,a painful musculoskeletal disorder, occurs commonly. The condition is characterized by “trigger points,” or hyperirritable focal spot in taut bands of skeletal muscle. These trigger points generate pain locally around the spot, but also in patterns up and down the range of affected muscle. An MPS diagnosis can often be the answer to other related conditions, such as tension headaches, tinnitus, temporomandibular joint pain and lower back pain.1
From a treatment standpoint, physicians often focus on finding the etiological lesion that actually causes the trigger points to become activated, after which they can treat the pain at the point of pathology. Trigger point injection is a common method of symptomatic relief and pain intervention. While dry-needling or acupuncture can sometimes also induce pain relief for patients, the delivery of cyclobenzaprine to the pathology via injection brings the additional benefits of the ingredient’s muscle relaxing properties.2
Because trigger points not only produce pain at the local site, but across the muscle group in a characteristic irradiated pain pattern, dry needling often cannot suppress these autonomic symptoms the same way trigger-point injection can. Cyclobenzaprine injected at a trigger point can suppress the muscle spasm without interfering with muscle function, reducing the spread of the irradiated pain outward from a trigger point. In a study reviewed in a Cochrane literature review, cyclobenzaprine was shown to be significantly more effective in reducing mean pain intensity from a patient’s baseline than injections of clonazepam, and above a placebo in a double-blind study. Another benefit of reducing spasms and irradiated pain is better sleep for MPS patients.3
Cyclobenzaprine for trigger point injections is an excellent candidate for in-office compounding for physicians, as well, since it’s recommended that the patient receive additional treatment immediately after the injection. The area should be palpated to ensure that the injection has eased all of the painful points—and if not, they should be isolated and injected—and stretching the muscle group can have a profound effect on the longevity of the patient’s pain relief following an injection session.4
What Role Can Compounded Cyclobenzaprine Play in Myofascial Pain Syndrome Treatment?
In addition to providing fast pain relief at the site of trigger points and throughout muscles as an injected formulation, cyclobenzaprine can also be used as an active ingredient in topical pain management medications. Prepared by a compounding pharmacist and often compounded with other APIs like ketoprofen and lidocaine, cyclobenzaprine in a topical analgesic can help ease MPS pain without trigger point injections or in combination with injection treatment.5
Topical analgesics are rarely meant as treatments for conditions as painful and with such deep-seated causes as MPS, but for pain intervention and management with a chronic condition, topicals have significant advantages over injected medications. For one, they result in far fewer adverse side effects. With no systemic absorption, a topical delivery method for pain creams or sprays means far less toxicity or opportunity for complications.
As with any topical analgesic, compounded creams containing cyclobenzaprine pose no risks to patients who use them as their pharmacist directs. Pharmacists should always be sure to instruct patients on the correct way to apply topical creams and also educate patients about the dangers of procuring creams from potentially dangerous sources like overseas or without working personally with a licensed compounding pharmacist.
For patients with intense pain from MPS, a combination therapy of trigger point injection with cyclobenzaprine and potentially a topical cream or spray formulated with a combination of APIs including cyclobenzaprine can provide a strong level of pain relief. As part of a patient’s health care team, a pharmacist can help assess what medications work best with a physician’s diagnosis of MPS and the location and pathology of each specific patient’s trigger points.
Pharmaceutica North America is a premier provider of high-quality active pharmaceutical ingredients and compounding kits for pharmacists and physicians who wish to give their patients the highest level of customized care. Contact us to learn more about our bulk and unit-dose cyclobenzaprine and cyclobenzaprine ACTIVE kits.
- “Trigger Points: Diagnosis and Management,” Feb. 2002, http://www.aafp.org/afp/2002/0215/p653.html ↩
- “A New Look at Trigger Point Injections,” Sept. 2011, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182370/ ↩
- “Myofascial Pain Syndrome: A Treatment Review,” Feb. 12, 2013, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107879/ ↩
- “Trigger Points: Diagnosis and Management,” Feb. 15, 2002, http://www.aafp.org/afp/2002/0215/p653.html ↩
- “Pain Medication Preparations,” accessed Dec. 17, 2015, http://centraldrugsrx.com/pdf/Pain_Medications_Guide_-_letter_nm.pdf ↩