THE BENZODIAZEPINES AS ADJUVANT ANALGESICS

There has been long-standing debate regarding whether benzodiazepines possess analgesic properties that are independent of their effects on mood and alertness. A careful review of the literature reveals insuffi cient evidence to support the contention that the benzodiazepines have meaningful analgesic properties in most clinical circumstances. Treat ment with the benzodiazepines may reduce complaints of pain, but this seems to be an indirect effect related to their psychotropic propertie s, such as alleviation of anxiety and, in selected cases, depression. In the absence of definitive data, clinical experience suggests a pote ntial role for treatment with benzodiazepines for acute muscle spasm c oncomitant chronic pain and anxiety, and lancinating neropathic pain i n which case clonazepam and alprazolam may be the agents of choice. Th ey should probably not be considered as first-line choices even for th e above indications, since potential benefits must be considered in th e context of potential for the development of cognitive impairment, ph ysical and psychological dependence, worsening depression, overdose, a nd other side effects.