Benzodiazepines in chronic pain

There is limited medical evidence to support long-term benzodiazepines (BDZ) use; rather, there is increasing concern with respect to adverse events and drug interactions, particularly as the population ages. An article published in Pain Medicine in 2015 entitled “Benzodiazepine Use among Chronic Pain Patients Prescribed Opioids: Associations with Pain, Physical and Mental Health, and Health Service Utilization” by Nielsen et al. examined a 1,220-patient sample from a prospective cohort study of chronic non-cancer pain (CNCP) patients prescribed long-term opioids.

The authors defined four distinct groups with varying degrees of BDZ use, from daily to none. Results showed that BDZ use was associated with greater pain severity, pain interference with life, lower feelings of self-efficacy with respect to pain, higher doses of opioids, antidepressant/antipsychotic use, substance use, and greater mental health comorbidity. Benzodiazepine use also correlated with greater use of emergency health care and services. The study concluded that CNCP patients using BDZ represent a high-risk group, and the high prevalence of BDZ use is inconsistent with guidelines for the management of CNCP or chronic mental health conditions. 

Registrants may request a copy of the above-mentioned article from the College library.

The College encourages registrants to evaluate the efficacy and necessity of using BDZ and Z-drugs in their patients. If a decision is made to discontinue them, it may be helpful to partner with the patient’s pharmacy to develop a schedule for tapering the medication and monitoring the patient during the process. 

RACE line

Employees in the College’s drug programs are available to assist with questions, but they cannot direct patient care. Other resources such as peers, specialists, specialty clinics, and the RACE line should be contacted depending on the specific question. The RACE line (Rapid Access to Consultative Expertise) is a shared-care telephone advice line addressing a variety of topics, and promises a return call within two hours. Recently, the eRACE app was launched for mobile users. For more information on RACE, visit www.raceconnect.ca.