Benzodiazepine Use in Chronic Pain Management

Risks and Alternatives

The American College of Physicians and other guideline societies recommend against the use of benzodiazepines like diazepam for chronic pain management due to lack of analgesic efficacy and significant safety concerns, including increased overdose risk when combined with opioids 1, 2
Benzodiazepines contribute to the risk of opioid analgesic overdose and cause anterograde amnesia, with long-term use associated with cognitive impairment and dementia in the general population 1, 2

For neuropathic pain, first-line treatments include antidepressants like duloxetine and venlafaxine, anticonvulsants like gabapentin and pregabalin, and topical lidocaine 3, 4, 5, 6
For fibromyalgia, FDA-approved treatments include pregabalin, duloxetine, and milnacipran, as well as the muscle relaxant cyclobenzaprine 3, 7, 8
For low back pain and osteoarthritis, first-line treatments include NSAIDs, acetaminophen, and physical interventions like epidural blockade for specific cases 7, 8

Opioids may be considered as second-line treatments for certain neuropathic pain conditions, though they have limited effectiveness in chronic noncancer pain overall 3, 4
Tramadol may be considered for fibromyalgia 3, 7, 8