The Role of

Muscle Relaxant
in LBP
Management
 1 Health
Problem
Most
disability

The lifetime prevalence of Low Back Pain is 84%

Prevalence increases and peaks between the ages

of 35 and 55

healthdata.org, 2016
Balague, F. et.al. Non-specific low back pain. Lancet. 2012
Jenkin, H. Classification of Low Back Pain. ACO. 2002.
 DEFINISI LBP
 Nyeri yang timbul pada bagian posterior regio
yang terletak diantara batas bawah costa
terbawah dan tungkai proksimal.

 Klasifikasi LBP berdasarkan durasinya :

 Akut: < 6 minggu.
 Subakut: 6-12 minggu
 Kronik: > 12 minggu

Black, J.M., & Jacob, E.M., 2005

 KLASIFIKASI LBP
• Specific LBP (1-2%)
LBP yang disebabkan oleh adanya penyebab yang
mendasari (penyakit sistemik, infeksi, injury, trauma,
deformitas struktural).

• Nonspecific LBP (85-90%)

LBP yang tidak diketahui penyebab struktural yang
menyebabkan nyeri.
Etiologi – Specific LBP

1. Mechanical Spinal Condition (97%)

2. Non-mechanical Spinal Condition (1%)
3. Non-spinal/Visceral Disease (2%)
Etiologi - Mechanical Spinal Condition (97%)

▫ Lumbar strain / sprain (70%)

▫ Degenerative disc / facets (10%)
▫ Disc herniation (4%)
▫ Spinal stenosis (3%)
▫ Osteoporotic compression fracture (4%)
▫ Spondylolisthesis (2%)
▫ Fraktur akibat trauma(<1%)
▫ Penyakit kongenital (<1%)
▫ Spondylolysis (stress fracture)
▫ Spinal instability and internal disc disruption
(controversial)
Etiologi - Non-mechanical Spinal Condition (1%)

• Neoplasia (0.7%):
▫ Multiple myeloma, payudara, paru, prostat, ginjal, lymphoma /
leukemia, spinal cord, vertebral, retroperitoneal

• Infection (0.01%):
▫ Osteomyelitis, septic discitis, paraspinous abscess, epidural
abscess, shingles

• Inflammatory arthritis (HLA-B27) (0.3%):

▫ Ankylosing spondylitis, psoriatic spondylitis, Reiter, IBD

• Paget and Scheuermann disease

Etiologi - Visceral (2%)

• Aneurisma aorta
• Penyakit pada Pelvis: prostatitis, endometriosis,
PID
• Penyakit pada ginjal: nephrolithiasis,
pyelonephritis, abses perinephric
• Penyakit pada saluran pencernaan: pankreatitis,
cholecystitis, penetrating ulcer
Do you often experience
patients with Low Back Pain?

The most important aspect to

consider…
 Low Back Pain is associated with Muscle
Spasm

Spam
s
Pain Pain
Spas
m
Beltrame, 2008
1
Chandanwale, at al. Evaluation of eperisone hydrochloride in the treatment of acute musculoskeletal spasm
associated with low back pain: A randomized, double-blind, placebo-controlled trial. Journal of Postgraduate
Medicine 2011;57(4):278-285
Eperisone is effective in reducing FFD in patients with
F in g e r - f lo o r - s u r f a c e d is t a n c e

acute musculoskeletal spasm associated with LBP

( in m m )

* P<0.001

150.66 Eperisone
160
138.51 Placebo
140 123.82
*
110.8
120
103.39 101.6

100 *
80 69.03

60
41.75

40

20

0
Baseline Day 3 Day 7 Day 14

Modified: Chandanwale, at al. Evaluation of eperisone hydrochloride in the treatment of acute musculoskeletal spasm associated with low back pain: A randomized, double-
blind, placebo-controlled trial. Journal of Postgraduate Medicine 2011;57(4):278-285
 Eperisone is effective in reducing hypermyotonia in
patients with acute musculoskeletal spasm associated
with LBP
H yperm yotonia scale

*Eperisone
P<0.001
1.8 1.67
Placebo
1.6 1.49 1.46

1.4 1.29
1.18
*
1.2 1.02
1
*
0.8 0.69

0.6
*
0.37
0.4

0.2

0
Baseline Day 3 Day 7 Day 14

Hypermyotonia – Assessed on a 4-point rating scale of 0=absent or normal, 1=Mild hypertonia, 2=Moderate hypertonia, with slight restriction of movement,
3=Marked hypertonia, with marked restriction of movement

Modified: Chandanwale, at al. Evaluation of eperisone hydrochloride in the treatment of acute musculoskeletal spasm associated with low back pain: A randomized, double-
blind, placebo-controlled trial. Journal of Postgraduate Medicine 2011;57(4):278-285
Eperisone has good therapy response and high profile of
tolerability in patients with acute musculoskeletal spasm
associated with LBP
79% patients response good to
excellent therapy after 14 days
treating with Myonal

Global Assessment of Therapy Response

97% patients response good to

excellent of tolerability of
Myonal

Global Assessment of Tolerability Response

Modified: Chandanwale, at al. Evaluation of eperisone hydrochloride in the treatment of acute musculoskeletal spasm associated with low back pain: A
randomized, double-blind, placebo-controlled trial. Journal of Postgraduate Medicine 2011;57(4):278-285
 Eperisone has good efficacy in reducing
muscle spasm associated with Low Back Pain

Eperisone has rapid relief for myotonic

symptom, since day 3 of treatment

Eperisone has good tolerability profile

for patients with muscle spams associated with Low
Back Pain
THANK YOU