Benzodiazepines May be Worse than Opioids: Negative Medication Effects in Severe Chronic Pain

Clin J Pain. 2015 May 8.

Authors: Gauntlett-Gilbert J1 et al

OBJECTIVES:

Opioid prescription for non-malignant pain is increasing in Europe and the US. Research and guidance have focused on the potential for dependency and medical side effects with high doses. In contrast, benzodiazepines have received little attention in the chronic pain literature, despite evidence for dependency and cognitive impairment in long term use. We aimed to examine the relationship between these classes of medication use, mood and functioning.

METHODS:

This cross sectional study included patients (N=229) with disabling chronic pain who were about to start intensive pain rehabilitation. They completed self-report measures of mood, functioning and responses to pain. We examined each patient’s medication use and calculated a single Morphine Equivalent (ME) dose per person, and a similar Diazepam Equivalent (DE) dose. We examined the relationship between drug dose, mood and functioning.

RESULTS:

Higher DE doses were associated with worse outcomes in most domains. Higher ME doses were more narrowly associated with worse functioning. There was no evidence for any benefit of these drugs; higher doses were not associated with less pain, fear or disability. Higher ME doses were not more problematic, contrary to our predictions. The combination of opioids and benzodiazepines was associated with particularly poor outcomes for mood.

DISCUSSION:

This study is the first to examine both opioid and benzodiazepine use together in chronic pain. We found the anticipated negative effects of opioid medication, and particularly consistent associations between benzodiazepine use and poor wellbeing. Future guidance on chronic pain prescription should focus on restricting benzodiazepine use.