Anything for muscular back problems that isn’t diazepam?

[SinkGirl]

I’ve had an ongoing upper back problem since I pumped for my twins. Most of the time it’s manageable but two or three times a year it flares up so badly I can’t move and am in agony and need a short course of diazepam to be able to manage to do my daily exercises. My twins are 4 but both have disabilities so need lots of lifting for changes etc - they’re at school now and getting that break from the lifting helps massively. But during lockdown 1 and now in the Christmas holidays it has flared up.

This time it started on Christmas Eve. I absolutely dread when this happens because aside from the pain, the worst thing about it is having to contact the GP and ask for medication because they always talk to me like I’m some kind of drug addict. I am already on morphine and naproxen for another condition, which do absolutely nothing for my back when it’s like this. Have been on them a long time, they regularly reduce it or extend the length between scripts even though I’m very responsible with it (all other options have been tried so I’m left with this basically).

This time I put off calling hoping that resting would be enough but by NYE I couldn’t breathe properly without pain (definitely muscular, not COVID) so I called.

I made it clear I don’t specifically want diazepam - I just want something that will help so I can get moving again but they always give me diazepam anyway.

It’s really annoying that the thing that works for my back is something that people take recreationally - I wish it was something else so I could have a supply in, and deal with it as soon as it starts rather than put it off because of the reaction.

Is there such a thing as muscle relaxants that don’t have the same effects as diazepam? Or something else helpful when it’s really bad. Maybe anything that works to relax muscles will make you feel this way?

Only thing GPs have done is refer me for two short courses of physio sessions - no scans or anything like that. They say that even slipped discs in the upper back don’t cause pain so it must just be muscular, and given diazepam works maybe they are right, but perhaps there’s an underlying issue. I have constant altered sensation in the skin on my upper back, which has spread from a small patch to my whole upper back and I get pins and needles in my hands and neck when it’s bad, and part of my spine is tender to touch. Maybe I need to push for a scan or pay for one myself somehow - most of the time I can manage it but when it’s like this i can’t function.

As you take morphine & naproxen then I would also recommend firstly taking paracetamol 1g 4 times a day on top.
Although paracetamol is the most basic pain relief is does work well with those two. But you have to take it regularly.

Speak to your GP about Gabapentin, it could help although it's more for nerve pain they do use it a lot in orthopaedics.
It can make you sleepy so be careful driving & don't stop it suddenly but cut down slowly if it doesn't help.

Try not to get into taking regular diazepam if possible because as you know as it's so addictive. But also it takes months to come off safely I believe.

I get muscular upper back pain flare ups quite bad.
I can only take minimal pain relief as I'm on lots of meds so it can be a nightmare.

The physio has recommended strengthening my core by doing exercises with hand weights which I am trying to do daily. I guess you've been told similar.
I find that when standing & walking good posture is essential.
Pilates is supposed to be excellent for back pain as is swimming in warm water. My sister found both those helped her back pain.

The key is to take the right pain relief to be able to keep moving & exercising.
I'm just thinking, I have used large heat patches on my back which helped - you can get them in a chemist or Tesco & they can be worn for a few hours.

Ps considering you have altered sensations I would definitely push for a scan

Amitriptyline? I take it for flank and back pain caused by kidney tumours. Works well, but does make you sleepy so have to take it at night. You have to take it continuously to work.

I would see an osteopath! I get the odd flare up of a pain directly under my bra strap, on 1 side. I often only need 1 session. Idealy, I'd push for a scan, but I'd certainly see an ostepath asap too.

I have had something similar with also an underlying pain condition. Currently on gabapentin, tramadol, paracetamol and amytriptaline combination as prescribed by pain consultant. Was better for me than morphine or zapain combo I was on before...

Worth pushing to see a pain consultant as they’re really worth their weight in gold when it comes to chronic pain.

Meant to say - have a look at neuropathic pain description - some of the symptoms you describe are similar to mine in terms of skin sensation (though mine was extreme - think burning and stabbing sensations). If it rings any bells, ask for a referral now to a pain consultant. I paid to go private as was 6 month wait, but he then referred me back into his nhs clinic so have seen him for years now. Good luck - I know how draining chronic pain can be - try to be kind to yourself in terms of your expectations of what you can / can’t do. It’s been the hardest part of it all for me - accepting limitations.

I had on/off back and neck muscle spasms for 3+ years due to hypermobility. They were excruciating, diazepan didn't touch it unless combined with plenty of booze (which I now think probably just resulted in me being unconscious).

The thing that fixed it was acupuncture done by a physio. Before that was tried (it was part of a medical trial) I had nortriptyline (related to amytripline) which made it more manageable. Tbh though the nicest thing to do during a flare-up was to get now DH to smother my spine in tiger balm, lie on my front and put a long heat pad on - it was the best muscle relaxant I found.

If you haven't tried acupuncture then I'd highly recommend it; make sure you get a qualified physio to do it - not Chinese acupuncture. You'll probably have to pay for it. I'd research some good local physio's and speak to them in advance so you have someone you can call in the event of a flare up

I think I'm missing something here. If diazepam works why not just take it? I had fairly major spinal surgery and, like you OP, I get muscular back pain every so often. Every so often I take diazepam for it. It works. I am not some drug fuelled monster because of it. Nor do my GP or healthcare professionals think I'm so tranqed out 1950s housewife.

Thanks all. Sorry I forgot to add I do take paracetamol too, I just meant prescriptions. Am currently lying on my heat pad, my favourite possession!

I have been under pain clinics many times for my endometriosis and adenomyosis and have variously been on amitriptylene and gabapentin / pregabalin which helped with the neuropathic pelvic pain but made my fatigue unmanageable. When my back first kicked off really badly I tried them again but they didn’t help at all, just as my other painkillers don’t help when it’s like this.

I also have peripheral neuropathy in my lower legs but the GPs say it’s unrelated since it’s my upper back and I probably have fibromyalgia but my symptoms don’t really fit. I think it’s just an easy way to get me to go away!

@badeyebri I don’t mind taking it but I hate having to ask for it - alongside the morphine they seem to think I’m some kind of addict I think, even though I managed to cut my morphine dose by 90% without any support needed when I was pregnant as my pelvic pain improved so much - sadly it didn’t last but I’ve kept my dose at about that level despite it worsening as they refuse to increase it again and want me to reduce further. They always ask me what I am asking for rather than suggesting it which I hate - I genuinely don’t want any effects from whatever I take other than less pain!

Have just taken the max dose I’m allowed of diazepam (8mg) and I don’t feel drowsy at all. They only give me 21 x 2mg tablets so at this dose it’s not even 2 days worth but hopefully that will be enough to get me moving again but they were very clear they wouldn’t be prescribing any more when it was done for this episode and if it doesn’t work they’ll have to consider other things - would like to know what those things are as maybe I could do whatever that is!

I’m definitely not worried I’m addicted to it as I had a few left following my last prescription which sat in my cupboard for months until it happened again.

I have tried accupuncture and various other things and had just started going to Pilates before lockdown 1. Need to get back to that.

I do worry there might be some damage to my back that’s not being addressed so think I need to ask again for a scan.

Our problems aren't as severe as yours, but we find Biofreeze works very well; it's what my chiropractor recommends.biofreeze.co.uk/biofreeze-spray-pump.html

Hubby takes most of these meds for terminal cancer and what's worked most is capsicum cream - it's made a huge difference tbh.

Thank you - will give that a go. I suspect anything effective I can try earlier will help it not get to this point. It happens because it hurts to move and then I stop moving and then seize up and it’s self perpetuating. If there was something I could have in that would help at that point I wouldn’t be in this mess. Leaving it a week before calling the doctor probably hasn’t helped but I just hate doing it.

@notapizzaeater

Hubby takes most of these meds for terminal cancer and what's worked most is capsicum cream - it's made a huge difference tbh.

So glad it’s helpful for him - I used to use the cream and patches for my endo but eventually they stopped helping. I think they work well for some pain but once my muscles are all spasming and I’m contorted then I guess muscle relaxants are needed - I just don’t know if there are others that doctors are happier to prescribe because they don’t zonk you out (not that these zonk me out anyway, I think I’d need a much higher dose to get that effect!).

I do swear by heat for pain generally - my electric heat pad is my best friend 😬

Can't comment on the drugs but I'd recommend a physio/osteopath who has expertise with post partum women. Preferably one who can add follow up Pilates or recommend one to you. The longer aim is most likely to strengthen your core as carrying twins pre and post birth will have taken it's toll. In the short term you need support to break the spasm cycle.
You might also get relief from a tens machine if you have one around or from an electronic muscle therapy tool. Not just on the direct area, but on the big muscles in lower back and legs.
You don't mention your age, hormonal changes and collagen levels might be a factor too
For self helps books, Back in Action is an oldie but goody.
You have my utmost sympathy.

No sure what painkillers you should use, but I would push for investigations, you might need an MRI scan.
For over a year I was told I had sciatica given every painkiller going, finally got a scan, slipped disc pushing on my spinal collum, I had even used a chiropractor and they didn't pick up on anything, hospital wasn't impressed by that.

Op I really think you should push for an mri, it's not true that should discs don't hurt. 90% of people with disc damage don't experience the pain you are describing, but an unlucky 10% of us do.

Get a second opinion. GPs are not the best qualified professionals to speak to about recurrent back pain.

That's not a big dose of diazepam. I get 28x5mg every 6-12months and take 5-10mg every 8 hours for 24-48hrs. Honestly I'd advise sitting down with you Dr and having a chat about all your pain meds. Taking lower doses that do nothing for the pain just increases tolerance with opioids and benzodiazepines. So you are best taking a higher dose for a shorter period of time IYSWIM. Things like NSAIDs and paracetamol should be taken regularly to prevent wind up. I always wonder if ketamine would help in these chronic pain situations but then the possibility for abuse would be massive.
Have you thought of opioid patches?
If it's a totally drug free treatment then you could do worse than searching for a physio that's offers Bowen and/or laser therapy. Laser is magic for muscle pain.

The physio has recommended strengthening my core by doing exercises with hand weights which I am trying to do daily

My physio recommended yoga to strengthen my core which will support my lower back. I've been practicing for 3 years and very flexible, have abs and a strong core. Still in pain every day. I take codeine and Paracetamol, amitriptyline. Deep heat works occasionally. I spend a lot of time lying on the floor with knees up to my chest

Thanks so much for all your advice, I really appreciate it. I have no concerns about taking medication, beyond the judgement from GPs. It’s very frustrating after being so responsible with my meds and cutting down so much on my own to be treated with so much distrust.

They will only give me 21x 2mg tablets and taking 8mg isn’t having much effect - I wonder if opiate tolerance means they are less effective, although they seem concerned that the combination is going to knock me out. Definitely not the case.

It’s difficult at the moment where you can’t make appointments with a specific GP - there is one who is much more understanding but I never get to speak to him. There’s on GP in particular who blames any issue I have on the painkillers i take and who randomly changes my prescription with no discussion. Drives me mad.

I’ve been on fentanyl patches in the past (obviously those wouldn’t be prescribed any more), OxyContin etc - over the years I’ve tried pretty much every painkiller and hormone treatment for my endo but morphine works best for me for that.

When the doctors are running a bit more normally (if that ever happens) I will definitely book an appointment with the understanding GP, talk about it all and try to get a referral for a scan. Will also try and sort out chiropractor / osteopath to see if it helps and get back to Pilates. I know my posture is a massive issue that I need to correct which I’m trying through the physio exercises. It can be set off by quite minimal exertion though which makes it so difficult. Hard enough caring for my boys with limited sleep and dealing with the endo pain but this back problem makes it all so much more difficult. At least they are going back to school on Monday so I can have a proper rest then!

Forgot to say I’m 38, still having frequent periods (have always had a short cycle) so don’t think perimenopause is an issue. I was on a drug that induced pseudo menopause years ago and I’ve had a lot of pain throughout my body since but bone scans were normal. Have had hormone blood tests, all normal except on one my oestrogen was quite low but when checked again was back in normal range. Have done quite a few thyroid blood tests some of which have been out of range but whenever GP repeats them they are completely normal, not even close to being out of range. B12 normal, vitamin d and folate were low but now much higher on supplements.

Definitely going to try and get my back checked out properly, and try to talk to GP about my meds. Even with my pelvic pain, the dose I’m on now really isn’t sufficient but just before Christmas I had yet another mrs review where they said they wanted me to reduce it and I said I’m not coping on what I’m on now, and they said well we will leave it as it is but don’t request it early as it will be refused. So on my worst days my pain isn’t managed at all because I know I will run out if I take more. Bloody ridiculous situation - they admit themselves there’s nothing more that can be done so I’m not sure what they expect me to do.

I think you're very wise to avoid diazepam. The effects on my MiL over the years she's taking it have been horrifying. She's like a ring wraith.

Agree with pps that you should try scan, osteopath, acupuncture, Pilates.

I've had awful lower back, upper back and neck pain in various phases especially since having children. Also spd which stuck around and seems to have caused some sort of more generalized pain condition. But getting to the root cause has always been the best way of dealing with each problem. A good osteopath be the place I'd start.

Do you have the money to go private for an mri? It costs about £400 (that's what is cost me to self pay 6 months ago through Nuffield) and it sounds like it is worth investigating a way to help fix the cause of the pain rather than throw drugs at it.

Now I think about it - and the state of my MiL - it's absolutely mind blowing that doctors are giving you prescriptions for such harmful drugs when you haven't had a scan, haven't tried acupuncture, don't have regular physio appointments.

MiL has degenerative arthritis so that she's in inevitable and worsening agony, so the choice to give her morphine and diazepam is understandable - even if the levels are now way out of control and likely to kill her. But her cognitive functioning is down to that of someone with advanced dementia.

It's just appalling to use these as first line of pain relief in a young woman who would probably benefit from deep tissue massage and some acupuncture.

From a muscular point of view I had limited success with Bacolfen but have been on Zanaflex for years now which has helped with major body spasms so that might be something worth talking to your gp about.

Heat is great for me I like tiger balm, capisum cream (but cant use it anymore). Like you I have been through a range of things.

I can't tolerate gabapentin, lyrica, codeine. They either don't metabolize it work too well in that I switch from a semi conscious state to a paranoid very unreasonable deeply suicidal state, take me off them and it all goes away. Diazepam is another no go as I have paradoxical effects from it.

Topical stuff like udder mint can help a bit too, it's in the vet section in veterinary counters and is aimed at cows udders.

How about magnesium for muscular spasms, if your levels are low it can cause spasms so that might be an easy fix