Benzodiazepine Use in Chronic Pain

the MPR take:

Benzodiazepines are often used by patients with chronic noncancer pain despite limited evidence of long-term benefits and the risk of adverse events and drug interactions. In the journal Pain Medicine, a prospective cohort study of 1,220 adult chronic noncancer pain patients prescribed long-term opioids found that one-third of participants reported use of benzodiazepines in the past month and 17% reported daily use. From those patients who had reported use within the past month, the most commonly taken benzodiazepine was diazepam, followed by temazepam, oxazepam, nitrazepam, alprazolam, and clonazepam.

Benzodiazepine use was associated with the following:

  • Greater pain severity, pain interference with life, and lower feelings of self-efficacy with respect to their pain.
  • Being prescribed “higher-risk” (>200 mg oral morphine equivalent) doses of opioids, using antidepressant and/or antipsychotic medications.
  • Substance use (including more illicit and injection drug use, alcohol use disorder, and daily nicotine use).
  • Greater mental health comorbidity.
  • Increased use of emergency healthcare in the past month compared to non-users.

Those noncancer chronic pain patients also taking benzodiazepines, especially those taking the medication daily, need to be carefully monitored and alternative strategies for mental health or substance use disorders should be considered for this population.

Benzodiazepines (BZDs) are commonly used by chronic pain patients, despite limited evidence of any long-term benefits and concerns regarding adverse events and drug interactions, particularly in older patients. This article aims to: describe patterns of BZDs use; the demographic, physical, and mental health correlates of BZD use; and examine if negative health outcomes are associated with BZD use after controlling for confounders.