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Perspectives

Do benzodiazepines have a role in the management of pain?

Ben Ware, Rachel Thorson

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Abstract

Despite the widespread prescription of benzodiazepines in patients with pain there is very little evidence of their effectiveness. In addition, their combined use with opioids can result in significant adverse effects and their long-term use has been associated with an increase in mortality.

Key Points

  • There is very limited evidence for the clinical efficacy of benzodiazepines in the treatment of patient with pain.
  • The current pattern of benzodiazepine prescribing in Australia most likely represents a high level of overuse given the relatively few indications for long-term benzodiazepine therapy.
  • The use of benzodiazepines can cause dependence and long-term use has been associated with increased mortality while their potential for misuse and abuse is well documented.
  • Concurrent use of benzodiazepines and opioids is associated with significant risks such as increased cognitive and psychomotor impairment, respiratory depression, sedation and overdose.
  • National guidelines (from the RACGP) recommend that a pain specialist is involved in the care of patients with chronic pain who take multiple psychoactive medications including benzodiazepines.
  • Initiation of benzodiazepines in the management of chronic pain should be limited to a pain specialist experienced in their use.

    Picture credit: © Serg64/Depositphotos.

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