I went to the local emergency clinic for a new start-up of pain in my back that goes into the buttock and down the leg. The last MRI I had done showed that the pain was coming from a disc protrusion. They gave me pain killers and muscle relaxants. I’ve always been told by my regular doctor not to take muscle relaxers for this problem.

Acute lumbar disc prolapse can be very painful. Back pain that goes down the leg (called sciatica) often brings the patient in to the physician’s office for help. Pain is managed with physical therapy and medications such as antiinflammatories.

Another form of drug therapy is with muscle relaxers/relaxants. The most common drug family of muscle relaxants used are the benzodiazepines (e.g., Librium, Valium). These drugs are also used to treat anxiety because they have a sedative effect. But concerns about side effects of benzodiazepines has brought into question whether they should be used at all for acute low back pain associated with lumbar disc prolapse.

In general, benzodiazepines are considered safe and effective when used on a short term basis. Long-term use is really the sticking point. These medications can cause adverse psychological and physical effects. Patients can become addicted and become physically dependent on the drug. Withdrawal symptoms may occur when attempting to stop taking them.

In a recent study, the role of one specific benzodiazepine (diazepam, also known as valium) in the management of acute low back pain with sciatica was reviewed. All 60 patients enrolled in the study had been diagnosed as having a lumbar disc prolapse using imaging studies (CT scans and MRIs).

As a quick review of this problem, remember that disc prolapse is a type of disc herniation. The three main types of disc herniation can actually be divided into disc prolapse, disc herniation, and disc sequestration. In the case of a prolapse, the disc is bulging.

The inner portion of the disc (the nucleus) is intact has migrated or moved into the outer covering called the annulus. The direction of the disc material is usually backwards toward the spinal canal. A bulge or prolapsed disc can be large enough to actually press against the nearby spinal nerve root causing back and/or leg pain (sciatica).

The pain causes muscles to contract and hold that contracted position. The result is a protective muscle spasm that really only increases the pain. Muscle relaxants like diazepam are meant to break the pain-spasm cycle by relaxing the muscles in spasm.

It has been suggested that muscle relaxants actually work against the goal of taking pressure off the spinal nerve. Muscle spasm and tightness can aid in putting pressure on the spine to maintain a position that will push the protruding disc back in place. The use of antiinflammatories, analgesics (pain relievers), and physical therapy remain the most effective management plan for this problem.