Cyclobenzaprine for Globus and Laryngeal Symptoms

Understanding the Pathophysiology

Globus pharyngeus is a functional disorder characterized by a sensation of a lump in the throat without structural pathology, presenting as a recurrent, non-painful but uncomfortable sensation in the absence of dysphagia, odynophagia, or GERD, and is linked to pharyngolaryngeal tension and aberrant learned behaviors rather than true muscle spasm requiring relaxation 1, 3, 4
The condition is also linked to psychological stress and high emotional intensity, though psychiatric disorders may be an outcome rather than a predisposing factor 2, 5
Globus pharyngeus co-occurs with functional voice disorders and laryngeal hypersensitivity syndrome 1, 4

The American Academy of Otolaryngology recommends speech and language therapy as the primary intervention for functional laryngeal disorders 1, 2
Antidepressants are sometimes used based on evidence of benefit in overlapping disorders causing esophageal discomfort, as recommended by the American Gastroenterological Association 1, 3, 5
Behavioral interventions targeting avoidance behaviors and pharyngolaryngeal tension are the mainstay of treatment, according to the American Psychological Association 1, 4

The sensation of throat tightness in globus should not be mistaken for true muscle spasm, as it is a sensory phenomenon, not a contractile disorder requiring muscle relaxation 2, 3, 5
Globus improves with eating and is more obvious between meals, a pattern inconsistent with skeletal muscle spasm 2, 4
Positive diagnostic features include the absence of drooling or excessive oral secretions despite reported difficulty swallowing, as noted by the American Academy of Otolaryngology 1, 3

Long-term use of cyclobenzaprine can lead to withdrawal symptoms including malaise, nausea, and headache requiring a 2-3 week taper, as warned by the National Institute of Health 6