{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T10:20:35Z","timestamp":1782296435787,"version":"3.54.5"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T00:00:00Z","timestamp":1614816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"University of Florida Center for Drug Evaluation and Safety for data access and computing"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,10,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine the prevalence and duration of skeletal muscle relaxant (SMR) treatment among commercially insured adults in the United States.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used the MarketScan Research Database to identify a cohort of adults 18 to 64\u2009years who had \u22652-year continuous enrollment between 2005 and 2018. We estimated the prevalence of SMR treatment using a repeated cross-sectional design and derived treatment duration using the Kaplan-Meier method. Analyses were stratified by age group, sex, geographic region, individual SMR agent, and musculoskeletal disorder.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>48.7 million individuals were included. Treatment prevalence ranged from 61.5 to 68.3 per 1,000. About one-third of users did not have a preceding musculoskeletal disorder diagnosis. Cyclobenzaprine was the dominant agent accounting for &amp;gt;50% of prescriptions. The considerable growth in the use of baclofen, tizanidine, and methocarbamol paralleled with a decline in carisoprodol and metaxalone use. The prevalence was highest in the South while lowest in the Northeast. The median treatment duration was 14\u2009days with 4.0%, 1.9%, and 1.0% of individuals using SMRs for more than 90, 180, and 365\u2009days, respectively. Compared with cyclobenzaprine, patients initiating baclofen, tizanidine, and carisoprodol had longer treatment duration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>SMRs are widely used in the United States. Their use slightly increased in recent years, but trends varied among individual agents, patient groups, and geographic regions. Despite limited evidence to support efficacy, a sizable number of U.S. adults used SMRs for long-term and off-label conditions. Further study is needed to understand determinants of treatment as well as outcomes associated with such use.<\/jats:p><\/jats:sec>","DOI":"10.1093\/pm\/pnab088","type":"journal-article","created":{"date-parts":[[2021,3,2]],"date-time":"2021-03-02T12:32:57Z","timestamp":1614688377000},"page":"2153-2161","source":"Crossref","is-referenced-by-count":13,"title":["Utilization Patterns of Skeletal Muscle Relaxants Among Commercially Insured Adults in the United States from 2006 to 2018"],"prefix":"10.1093","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6067-5574","authenticated-orcid":false,"given":"Yan","family":"Li","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Delcher","sequence":"additional","affiliation":[{"name":"Institute for Pharmaceutical Outcomes & Policy, Department of Pharmacy Practice & Science, College of Pharmacy, University of Kentucky, Lexington, KY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary M","family":"Reisfield","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, College of Medicine, University of Florida, Gainesville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Jung","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL"},{"name":"Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua D","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL"},{"name":"Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Almut G","family":"Winterstein","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL"},{"name":"Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL"},{"name":"Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,3,4]]},"reference":[{"issue":"3","key":"2021100819524035100_pnab088-B1","first-page":"365","article-title":"Choosing a skeletal muscle relaxant","volume":"78","author":"See","year":"2008","journal-title":"Am Fam Physician"},{"key":"2021100819524035100_pnab088-B2","year":"2013"},{"key":"2021100819524035100_pnab088-B3","year":"2016"},{"key":"2021100819524035100_pnab088-B4","volume-title":"Basic & Clinical Pharmacology","author":"Kruidering-Hall","year":"2015","edition":"13th edition"},{"key":"2021100819524035100_pnab088-B5","volume-title":"Comprehensive Treatment of Chronic Pain by Medical, Interventional, and Integrative Approaches","author":"Cohen","year":"2013"},{"issue":"2","key":"2021100819524035100_pnab088-B6","first-page":"CD004252","article-title":"Muscle relaxants for non-specific low back pain","author":"van Tulder","year":"2003","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"2021100819524035100_pnab088-B7","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.jpainsymman.2004.05.002","article-title":"Comparative efficacy and safety of skeletal muscle relaxants for spasticity and musculoskeletal conditions: A systematic review","volume":"28","author":"Chou","year":"2004","journal-title":"J Pain Symptom Manage"},{"issue":"10","key":"2021100819524035100_pnab088-B8","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1111\/joor.12539","article-title":"Pharmacological treatment of oro-facial pain\u2013Health technology assessment including a systematic review with network meta-analysis","volume":"44","author":"Haggman-Henrikson","year":"2017","journal-title":"J Oral Rehabil"},{"key":"2021100819524035100_pnab088-B9","doi-asserted-by":"crossref","first-page":"S83","DOI":"10.4103\/0972-2327.100023","article-title":"Tension type headache","volume":"15(suppl 1","author":"Chowdhury","year":"2012","journal-title":"Ann Indian Acad Neurol"},{"issue":"1","key":"2021100819524035100_pnab088-B10","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1002\/art.20076","article-title":"Treatment of fibromyalgia with cyclobenzaprine: A meta-analysis","volume":"51","author":"Tofferi","year":"2004","journal-title":"Arthritis Rheum"},{"issue":"6","key":"2021100819524035100_pnab088-B11","doi-asserted-by":"crossref","first-page":"e207664","DOI":"10.1001\/jamanetworkopen.2020.7664","article-title":"Assessment of physician prescribing of muscle relaxants in the United States, 2005-2016","volume":"3","author":"Soprano","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"6","key":"2021100819524035100_pnab088-B12","first-page":"427","article-title":"Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain","volume":"39","author":"Witenko","year":"2014","journal-title":"P&T"},{"issue":"7","key":"2021100819524035100_pnab088-B13","doi-asserted-by":"crossref","first-page":"480","DOI":"10.7326\/M16-2458","article-title":"Systemic pharmacologic therapies for low back pain: A systematic review for an American College of Physicians clinical practice guideline","volume":"166","author":"Chou","year":"2017","journal-title":"Ann Intern Med"},{"issue":"7","key":"2021100819524035100_pnab088-B14","doi-asserted-by":"crossref","first-page":"514","DOI":"10.7326\/M16-2367","article-title":"Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians","volume":"166","author":"Qaseem","year":"2017","journal-title":"Ann Intern Med"},{"issue":"24","key":"2021100819524035100_pnab088-B15","doi-asserted-by":"crossref","first-page":"E1406","DOI":"10.1097\/BRS.0b013e3181d952a5","article-title":"Diagnostic testing and treatment of low back pain in United States emergency departments: A national perspective","volume":"35","author":"Friedman","year":"2010","journal-title":"Spine"},{"issue":"7","key":"2021100819524035100_pnab088-B16","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/j.spinee.2011.03.017","article-title":"Real-world practice patterns, health-care utilization, and costs in patients with low back pain: The long road to guideline-concordant care","volume":"11","author":"Ivanova","year":"2011","journal-title":"Spine J"},{"issue":"8","key":"2021100819524035100_pnab088-B17","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1097\/00007632-200404150-00014","article-title":"Skeletal muscle relaxant use in the United States: Data from the Third National Health and Nutrition Examination Survey (NHANES III)","volume":"29","author":"Dillon","year":"2004","journal-title":"Spine"},{"issue":"23","key":"2021100819524035100_pnab088-B18","doi-asserted-by":"crossref","first-page":"E531","DOI":"10.1097\/01.brs.0000146453.76528.7c","article-title":"Prescription of nonsteroidal anti-inflammatory drugs and muscle relaxants for back pain in the United States","volume":"29","author":"Luo","year":"2004","journal-title":"Spine"},{"issue":"17","key":"2021100819524035100_pnab088-B19","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1001\/jamainternmed.2013.8992","article-title":"Worsening trends in the management and treatment of back pain","volume":"173","author":"Mafi","year":"2013","journal-title":"JAMA Intern Med"},{"key":"2021100819524035100_pnab088-B20"},{"issue":"2","key":"2021100819524035100_pnab088-B21","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1002\/acr.20064","article-title":"Health care utilization for musculoskeletal disorders","volume":"62","author":"MacKay","year":"2010","journal-title":"Arthritis Care Res"},{"issue":"4","key":"2021100819524035100_pnab088-B22","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1006\/enfo.2001.0061","article-title":"Detecting trends using Spearman\u2019s rank correlation coefficient","volume":"2","author":"Gauthier","year":"2001","journal-title":"Environ Forens"},{"issue":"3","key":"2021100819524035100_pnab088-B23","first-page":"69","article-title":"Statistics corner: A guide to appropriate use of correlation coefficient in medical research","volume":"24","author":"Mukaka","year":"2012","journal-title":"Malawi Med J"},{"issue":"2","key":"2021100819524035100_pnab088-B24","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1080\/17512433.2019.1565992","article-title":"Guideline recommendations on the pharmacological management of non-specific low back pain in primary care\u2013Is there a need to change?","volume":"12","author":"Schreijenberg","year":"2019","journal-title":"Expert Rev Clin Pharmacol"},{"key":"2021100819524035100_pnab088-B25","year":"2017"},{"key":"2021100819524035100_pnab088-B26","volume-title":"Guideline for the Evaluation and Management of Low Back Pain: Evidence Review","author":"Chou","year":"2007"},{"issue":"13","key":"2021100819524035100_pnab088-B27","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1001\/archinte.161.13.1613","article-title":"Cyclobenzaprine and back pain: A meta-analysis","volume":"161","author":"Browning","year":"2001","journal-title":"Arch Intern Med"},{"issue":"5","key":"2021100819524035100_pnab088-B28","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1002\/pds.4771","article-title":"The diversion of nonscheduled psychoactive prescription medications in the United States, 2002 to 2017","volume":"28","author":"Kurtz","year":"2019","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2021100819524035100_pnab088-B29","first-page":"77330","article-title":"Schedules of controlled substances: Placement of carisoprodol into schedule IV","year":"2011","journal-title":"Federal Register"},{"key":"2021100819524035100_pnab088-B30","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.drugalcdep.2019.05.025","article-title":"Impact of schedule IV controlled substance classification on carisoprodol utilization in the United States: An interrupted time series analysis","volume":"202","author":"Li","year":"2019","journal-title":"Drug Alcohol Depend"},{"issue":"2","key":"2021100819524035100_pnab088-B31","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1097\/AJP.0000000000000248","article-title":"Accuracy of self-reported prescribed analgesic medication use: Linkage between the Quebec pain registry and the Quebec administrative prescription claims databases","volume":"32","author":"Lacasse","year":"2016","journal-title":"Clin J Pain"},{"issue":"1","key":"2021100819524035100_pnab088-B32","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1002\/cpt.1807","article-title":"Risk of opioid overdose associated with concomitant use of opioids and skeletal muscle relaxants: A population-based cohort study","volume":"108","author":"Li","year":"2020","journal-title":"Clin Pharmacol Ther"},{"issue":"2","key":"2021100819524035100_pnab088-B33","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1300\/J069v18n02_05","article-title":"Carisoprodol (Soma): Abuse potential and physician unawareness","volume":"18","author":"Reeves","year":"1999","journal-title":"J Addict Dis"},{"key":"2021100819524035100_pnab088-B34","doi-asserted-by":"crossref","first-page":"107693","DOI":"10.1016\/j.drugalcdep.2019.107693","article-title":"Overlapping prescriptions of opioids, benzodiazepines, and carisoprodol: \u201cHoly Trinity\u201d prescribing in the state of Florida","volume":"205","author":"Wang","year":"2019","journal-title":"Drug Alcohol Depend"},{"issue":"10","key":"2021100819524035100_pnab088-B35","doi-asserted-by":"crossref","first-page":"1891","DOI":"10.1111\/j.1532-5415.2011.03559.x","article-title":"Trends in use of high risk medications for older veterans: 2004-2006","volume":"59","author":"Pugh","year":"2011","journal-title":"J Am Geriatr Soc"},{"key":"2021100819524035100_pnab088-B36","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1471-2318-15-2","article-title":"Association of skeletal muscle relaxers and antihistamines on mortality, hospitalizations, and emergency department visits in elderly patients: A nationwide retrospective cohort study","volume":"15","author":"Alvarez","year":"2015","journal-title":"BMC Geriatr"},{"issue":"2\u20133","key":"2021100819524035100_pnab088-B37","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/S0304-3959(97)00199-1","article-title":"Sex differences in the perception of noxious experimental stimuli: A meta-analysis","volume":"74","author":"Riley","year":"1998","journal-title":"Pain"},{"key":"2021100819524035100_pnab088-B38","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1097\/00003643-200219261-00003","article-title":"Epidemiology of analgesic use: A gender perspective","volume":"26(suppl","author":"Isacson","year":"2002","journal-title":"Eur J Anaesthesiol"},{"issue":"2","key":"2021100819524035100_pnab088-B39","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.1526-4637.2008.00558.x","article-title":"Sex-based differences in pain perception and treatment","volume":"10","author":"Paller","year":"2009","journal-title":"Pain Med"},{"issue":"5","key":"2021100819524035100_pnab088-B40","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.jpain.2008.12.001","article-title":"Sex, gender, and pain: A review of recent clinical and experimental findings","volume":"10","author":"Fillingim","year":"2009","journal-title":"J Pain"},{"issue":"11","key":"2021100819524035100_pnab088-B41","first-page":"2227","article-title":"The American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults","volume":"63","year":"2015","journal-title":"J Am Geriatr Soc"},{"issue":"10","key":"2021100819524035100_pnab088-B42","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1016\/j.jpain.2008.05.005","article-title":"Common chronic pain conditions in developed and developing countries: Gender and age differences and comorbidity with depression-anxiety disorders","volume":"9","author":"Tsang","year":"2008","journal-title":"J Pain"},{"issue":"3","key":"2021100819524035100_pnab088-B43","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1097\/AJP.0b013e31815d3619","article-title":"Response to morphine in male and female patients: Analgesia and adverse events","volume":"24","author":"Bijur","year":"2008","journal-title":"Clin J Pain"},{"issue":"2","key":"2021100819524035100_pnab088-B44","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/S0009-9236(03)00152-8","article-title":"Side effects of opioids during short-term administration: Effect of age, gender, and race","volume":"74","author":"Cepeda","year":"2003","journal-title":"Clin Pharmacol Ther"},{"issue":"1","key":"2021100819524035100_pnab088-B45","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1097\/ACO.0000000000000541","article-title":"Risk factors for opioid-induced respiratory depression and failure to rescue: A review","volume":"31","author":"Gupta","year":"2018","journal-title":"Curr Opin Anaesthesiol"},{"issue":"8","key":"2021100819524035100_pnab088-B46","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1097\/00007632-200404150-00012","article-title":"Patterns and trends in opioid use among individuals with back pain in the United States","volume":"29","author":"Luo","year":"2004","journal-title":"Spine"},{"key":"2021100819524035100_pnab088-B47","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.jsr.2014.09.001","article-title":"Variation among states in prescribing of opioid pain relievers and benzodiazepines\u2013United States, 2012","volume":"51","author":"Paulozzi","year":"2014","journal-title":"J Safety Res"},{"issue":"2","key":"2021100819524035100_pnab088-B48","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1111\/j.1748-0361.2012.00428.x","article-title":"Regional differences in prescribing quality among elder veterans and the impact of rural residence","volume":"29","author":"Lund","year":"2013","journal-title":"J Rural Health"},{"issue":"21","key":"2021100819524035100_pnab088-B49","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.1056\/NEJMp1010220","article-title":"Geographic variation in the quality of prescribing","volume":"363","author":"Zhang","year":"2010","journal-title":"N Engl J Med"},{"key":"2021100819524035100_pnab088-B50","year":"2020"}],"container-title":["Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/painmedicine\/advance-article-pdf\/doi\/10.1093\/pm\/pnab088\/37110322\/pnab088.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/painmedicine\/article-pdf\/22\/10\/2153\/40533869\/pnab088.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/painmedicine\/article-pdf\/22\/10\/2153\/40533869\/pnab088.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,25]],"date-time":"2024-08-25T04:34:39Z","timestamp":1724560479000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/painmedicine\/article\/22\/10\/2153\/6159328"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,4]]},"references-count":50,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,3,4]]},"published-print":{"date-parts":[[2021,10,8]]}},"URL":"https:\/\/doi.org\/10.1093\/pm\/pnab088","relation":{},"ISSN":["1526-2375","1526-4637"],"issn-type":[{"value":"1526-2375","type":"print"},{"value":"1526-4637","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,10,1]]},"published":{"date-parts":[[2021,3,4]]}}}