TIZANIDINE IN THE MANAGEMENT OF MUSCULOSKELETAL PAIN, WITH PARTICULAR EMPHASIS ON BACK PAIN: MECHANISM OF ACTION, EFFICACY, SAFETY, AND CLINICAL USE – A LITERATURE REVIEW

Krystian Kaczmarek; Wiktoria Zawada; Zofia Jadwiga Leszczyńska; Vladyslav Romaniuk; Urszula Szuleta; Agnieszka  Benecka; Jakub  Pietrończyk; Alicja Benecka; Zuzanna  Wieczorek; Iga Tartas; Natalia Prankiewicz

doi:10.31435/ijitss.3(51).2026.6465

Authors

Krystian Kaczmarek J. Strus City Multispecialty Hospital, Szwajcarska 3, 61-285 Poznań, Poland https://orcid.org/0009-0003-6026-1608
Wiktoria Zawada J. Strus City Multispecialty Hospital, Szwajcarska 3, 61-285 Poznań, Poland https://orcid.org/0009-0007-5871-2640
Zofia Jadwiga Leszczyńska J. Strus City Multispecialty Hospital, Szwajcarska 3, 61-285 Poznań, Poland https://orcid.org/0009-0009-4584-1130
Vladyslav Romaniuk Prof. S. T. Dąbrowski Hospital in Puszczykowo S.A., 11 Józefa Ignacego Kraszewskiego Street, 62-040 Puszczykowo, Poland https://orcid.org/0009-0002-9674-4188
Urszula Szuleta J. Strus City Multispecialty Hospital, Szwajcarska 3, 61-285 Poznań, Poland https://orcid.org/0009-0004-1795-7439
Agnieszka Benecka J. Strus City Multispecialty Hospital, Szwajcarska 3, 61-285 Poznań, Poland https://orcid.org/0009-0004-9295-7471
Jakub Pietrończyk University Clinical Hospital in Poznań, Przybyszewskiego 49, 60-355 Poznań, Poland https://orcid.org/0009-0006-6566-7537
Alicja Benecka Prof. S. T. Dąbrowski Hospital in Puszczykowo S.A., 11 Józefa Ignacego Kraszewskiego Street, 62-040 Puszczykowo, Poland https://orcid.org/0009-0000-5110-8028
Zuzanna Wieczorek J. Strus City Multispecialty Hospital, Szwajcarska 3, 61-285 Poznań, Poland https://orcid.org/0009-0005-9952-780X
Iga Tartas J. Strus City Multispecialty Hospital, Szwajcarska 3, 61-285 Poznań, Poland https://orcid.org/0009-0007-5602-2259
Natalia Prankiewicz University Centre of Dentistry and Specialized Medicine, Bukowska 70, 60-812 Poznań, Poland https://orcid.org/0009-0007-5865-7063

DOI:

https://doi.org/10.31435/ijitss.3(51).2026.6465

Keywords:

Tizanidine, Musculoskeletal Pain, Low Back Pain, Skeletal Muscle Relaxants

Abstract

Musculoskeletal pain, including back pain, is a leading cause of disability worldwide and often coexists with increased paraspinal muscle tension and painful muscle spasm. This narrative review aimed to summarize current knowledge on the mechanism of action, clinical efficacy, safety profile, and clinical use of tizanidine in musculoskeletal pain, with particular emphasis on back pain. The review included clinical trials, systematic reviews, case reports, clinical practice guidelines, prescribing information, and toxicological data concerning tizanidine. Tizanidine is a centrally acting alpha-2 adrenergic receptor agonist that inhibits polysynaptic spinal reflexes and exhibits both antispastic and antispasmodic effects, with possible involvement of imidazoline receptors. Earlier studies suggested that adding tizanidine to nonsteroidal anti-inflammatory drugs may improve outcomes in acute low back pain, whereas more recent randomized trials did not confirm additional clinical benefit. The most common adverse effects include drowsiness, dry mouth, hypotension, dizziness, and weakness. Rare but serious adverse effects include hallucinations, bradycardia, hepatotoxicity, and withdrawal symptoms after abrupt discontinuation. Strong CYP1A2 inhibitors, especially ciprofloxacin and fluvoxamine, markedly increase the risk of hypotension and excessive sedation. Evidence on the efficacy of tizanidine remains inconsistent. Tizanidine is not a first-line treatment but may be considered as short-term adjunctive therapy in selected patients when a muscular component is clinically relevant.

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