Limited Utility for Benzodiazepines in Chronic Pain Management: A Narrative Review

Area of Science:

• Pharmacology
• Pain Management
• Neurology

Background:

• Controversy surrounds the use of benzodiazepine receptor agonists (BZRAs) in pain management.
• This review aims to clarify the appropriate role of BZRAs in pain treatment.
• Challenges in BZRAs' application for pain require careful consideration by prescribers.

Purpose of the Study:

• To determine the appropriate role of BZRAs in pain management.
• To develop practice recommendations for BZRAs in pain management.
• To address challenges associated with BZRAs in pain management.

Main Methods:

• A narrative review of available research was conducted.
• Publications were identified through PubMed, reference lists, guidelines, and personal files.
• The review focused on determining the efficacy and appropriate use of BZRAs in pain management.

Main Results:

• BZRAs demonstrated analgesic benefits for burning mouth syndrome and stiff person syndrome.
• Efficacy for other pain conditions could not be concluded due to limited research and small sample sizes.
• BZRAs may help with co-occurring insomnia and anxiety but should be used short-term (2-4 weeks) and only when alternatives are inadequate.

Conclusions:

• BZRAs are often inappropriately used in pain management and their use should be limited to specific conditions.
• Loss of efficacy and adverse effects, including dependence (20-100% with >1 month use), limit BZRAs' utility.
• Discontinuation of BZRAs prescribed for 4 weeks or more should involve a slow, supported tapering process (12-18+ months).