79 - Limited Utility of Benzodiazepines in Chronic Pain Management
Steven Wright1, Terri Schrieber2
1Alliance for Benzodiazepine Best Practices, Portland, OR, USA. 2The Schreiber Research Group, Denver, CO, USA
Methods A search for relevant studies regarding benzodiazepine analgesic efficacy and adverse outcomes for 111 pain conditions took place January-February 2020. The search was performed within the PubMed electronic database, reference lists of relevant articles, published guidelines, and the author's personal files. Inclusion criteria: clinical trials, reviews, meta-analyses that compared benzodiazepines with placebo or other medications. Exclusion criteria: research involving fewer than 20 study subjects or research that addressed acute pain, analgoanesthesia, intrathecal administration, or pediatric populations. Results A total of 9838 pain-related, citations related to pain were retrieved. Abstracts and full-text articles of relevant titles were reviewed if available and in English. From these, 189 related to chronic pain and met inclusion criteria. There was sufficient and clear evidence supporting the use of benzodiazepines for analgesic purposes for only 2 of 111 pain conditions examined: stiff person syndrome and burning mouth syndrome. For the other 109 pain conditions the following was found with respect to benzodiazepine analgesia: 1) Absence of evidence, 2) Insufficient evidence, 3) Inconclusive or mixed evidence, 4) Poor risk / benefit ratio, or 5) Ineffective. Conclusions Of 111 pain conditions examined, there was evidence supporting the use of benzodiazepines for analgesia in stiff person syndrome and burning mouth syndrome. Recommendations for benzodiazepine prescribing in pain management include limited initiation and duration (2-4 weeks), as well as to encourage, support, and assist patients in a slow (perhaps more than one year) tapering process for those on these agents for greater than one month.