According to wikipedia: Spasticity is a feature of altered skeletal muscle performance in muscle tone involving hypertonia; it is also referred to as an unusual "tightness", stiffness, and/or "pull" of muscles.
Clinically spasticity is defined as velocity dependent resistance to stretch, where a lack of inhibition results in excessive contraction of the muscles, ultimately leading to hyperflexia (overly flexed joints).
Spasticity is found in conditions where the brain and/or spinal cord are damaged or fail to develop normally; these include cerebral palsy, multiple sclerosis, spinal cord injury and acquired brain injuryincluding stroke. Muscles affected in this way have many other potential features of altered performance in addition to spasticity, including muscle weakness; decreased movement control; clonus (a series of involuntary rapid muscle contractions often symptomatic of muscle over-exertion and/or muscle fatigue); exaggerated deep tendon reflexes; and decreased endurance. "
Originally when these symptoms became a major part of my illness, Dr. B sent me to see Tamara the occupational therapist. She taught me some great pain management techniques as well as some great stretching, breathing and yoga positions to help with the stiffness, soreness and pain. When my current medications and pain management tools weren't enough to manage the ever growing tremors and pain, Dr B began adding muscle relaxers to my regiment. Muscle relaxers such as Flexeril Soma and Zanaflex are the main treatment options for spastcity and tremors.
A couple of weeks ago, I was having a conversation with my friend CT, who was also recently diagnosed with FMS. Her doctors have been putting her through the rotating gamut of medications and she asked me about my medications. I told her i had recently been put on Zanaflex 4's in addition to my flexeril 10's. She asked about how they were different from the somas she was on so I decided to do a little research and find out.
Turns out I am not the first person to be curious about the differences between these three heavily prescribed medications. When I did a goggle search a myriad of forum posts on all sorts of websites came up asking about the differences, which ones people found more effective, if they can be taken together etc. I have tried to compile and simplify the ridiculous amount of information into a realistic readable comparison between these drugs that so many FMS patients take on a daily basis.
SOMA - Generically called carisoprodol. this one is the most addictive of the 3. It has a lighter sedation effect so it is often prescribed first for daytime muscle tension. This medication works by blocking the sensory impulses in the brain that trigger pain and cause the body to react by contracting to protect the injured body part. Soma muscle relaxants deliver fast relief usually within minutes. This medication comes in 250mg and 350 mg doses. Common side effects you may experience include drowsiness, dizziness, headache, depression, blurred vision, insomnia, and hiccups. These side effects are mild and tend to go away within the first few weeks of treatment. do not quit this medication cold turkey, you will experience severe withdrawal symptoms. I skipped right over this drug from skelaxin and robaxin and went directly to flexeril. My doctor chose to skip Soma as a treatment option as she likes to limit the number of addictive medications any patient is on and I was already on several. So i have no real experience with this medication or its effects on FMS.
FLEXERIL -Also known as cyclobenzaprine. This medication comes in 5 mg (blue) and 10 mg (yellow). It has a heavy sedation effect especially in the beginning (doesn't do anything to me now). This medication is often prescribed to be taken at night especially in the beginning to help patients sleep more comfortably. This medication works by blocking the sensory impulses in the brain that trigger pain and cause the body to react by contracting to protect the injured body part. This mediation is the most prescribed of the 3 because it has the lowest frequency for addiction. Common side effects of Flexeril include drowsiness, dizziness, fatigue, blurred vision, and/or dry mouth. These side effects are temporary and tend to go away as your body gets adjusted to the medication. I have been on this medication for almost 2 years. I started on the 5 mg at night and then moved the 5 mg twice a day, and then to the 10 mg. Now i take this medication in combination with Zanaflex as part of my treatment regimine. It helped me deal with my muscle spasm issues but never completely removed them or soothed them.
ZANAFLEX - This muscle relaxant is the most powerful currently on the market and has a heavy sedation effect. This effect is increased by narcotic pain medication, other muscle relaxants, old/ allergy medication and medications for depression. This medication is often prescribed t be taken at night especially in the beginning to help patients sleep more comfortably. This is a short acting muscle relaxant. The peak for this medication is 1-2 hours after it is taken and the medication is totally gone from the body in 3-6 hours so you need to schedule doses accordingly. Zanaflex is available in both tablets and caplets and you should not switch freely between the two as they work very differently on the body.
Dr B had me titrate onto this medication over a 10 day period so my body could adjust to it slowly and I could see if It worked for me without it just knocking me on my butt. I assume since it is mildly addicting you would need to titrate back off of it to avoid withdrawl symptoms from going cold turkey. You may have withdrawal symptoms such as dizziness, fast heart rate, tremors, anxiety, and increased spasticity when you stop using Zanaflex after using it over a long period of time. Birth Control pills can increase the amount of zanaflex in your blood stream and cause your body to process it out more slowly, so be careful to discuss this with your doctor. This medication comes in the following doses:
- Zanaflex 4 mg - white, round tablets
- Zanaflex 2 mg - blue capsules
- Zanaflex 4 mg - white and blue capsules
- Zanaflex 6 mg - light blue capsules with white stripe
The combination of Flexeril 10 in the morning and Zanaflex 2mg at lunch and dinner and then 4 mg at bed seems to currently be working for me at the moment. The frequency of my muscle specific spasms such as eye twitches, quad cramps and twitches and such as gone down significantly. The body tremors and hand shakes still come and go with a little less ferocity. I still have constant tightness and stiffness in pretty much all of my muscles especially my back, butt and legs. But I know there is no magic bullet.
and of course I am not a doctor. Please consult your doctor or pharmacist before changing your medications or dosages. Id love your comments and feedback on these medications.!
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