The present invention provides compositions comprising carisoprodol or pharmaceutically acceptable salts, esters or derivatives thereof. In certain embodiments, the invention provides pharmaceutical compositions comprising the skeletal muscle relaxant carisoprodol and one or more additional active agents, such as one or more nonsteroidal antiinflammatory drugs (NSAIDs). The invention further provides methods of use of such compositions in preventing, alleviating and/or treating musculoskeletal pain, muscle spasms, or other non-malignant painful conditions including methods in which the circulating levels of the active pharmaceutical form of carisoprodol are controlled by use of extended- or controlled-release formulations or by strict control of dosage regimen, so as to reduce the level of somnolence observed with other muscle relaxant compositions.