Benzodiazepines are used in the procedural setting as part of anesthesia regimens because of their sedative, anxiolytic, and amnesic effects. A commonly used example is midazolam. However, benzodiazepines also have non-procedural uses. They are prescribed to treat anxiety disorders, insomnia, and other related disorders such as bipolar disorder, spastic disorders, and seizure disorders.1 In clinical practice, the medication is less commonly used in the treatment of chronic pain.

Achieving long-term relief in a chronic pain patient is an elusive goal. One study examined the role benzodiazepine receptor agonists play in promoting effective pain relief in two specific diseases, stiff person syndrome and burning mouth syndrome. Benzodiazepines are known anxiolytics that can function as muscle relaxants. Consequently, they can effectively treat hypertonia or muscle stiffness, which is the dominant symptom in stiff person syndrome, an autoimmune disease where the patient experiences spasms and rigidity in the muscles. Alprazolam, clonazepam, and zolpidem are deemed the best options for treating painful hypertonia. 2 Findings from Shin et al. demonstrate that clonazepam produces long-term pain relief during burning mouth syndrome. Since gamma-aminobutyric acid or GABA receptors control pain and taste signaling pathways in the oral cavity, when clonazepam inhibits the accompanying GABA neurotransmitter, pain relief is accomplished.3

Visceral pain associated with irritable bowel syndrome or IBS has been attributed to the malfunction of the brain-gut axis in the nervous system. IBS is an abdominal disorder with a wide range of symptoms such as altered bowel habits, intestinal pain, and miscellaneous discomforts that do not present with an underlying cause. IBS relief is one of the non-procedural uses of benzodiazepines and has been linked to benzodiazepine receptors in the brain’s hypothalamus and subcortical areas, which, coincidentally, function as important regulators of autonomic processes. The motor and sensory activity in the gastrointestinal tract are autonomic processes managed by benzodiazepine receptors; thus, the administration of benzodiazepines regulates GI tract activity to reduce discomfort associated with IBS.4

Although these findings from Salari et al. strongly support the use of benzodiazepines for IBS relief, Wright’s findings indicate that this relief is short-term. His findings strongly discourage the long-term use of benzodiazepines, due to the risks of memory impairment.2 Numerous studies agree that the long-term use of benzodiazepines leads to adverse results in various cognitive processes such as working memory, processing speed, divided attention, recent memory, and expressive language. Individuals who stopped using benzodiazepines did not recover their memory, processing speed, and other cognitive strengths.6

References

1. Bounds CG, Nelson VL. “Benzodiazepines.” StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, https://www.ncbi.nlm.nih.gov/books/NBK470159/
2. Wright, Steven L. “Limited Utility for Benzodiazepines in Chronic Pain Management: A Narrative Review.” Advances in Therapy, vol. 37, no. 6, Springer Science and Business Media LLC, May 2020, pp. 2604–19. https://doi.org/10.1007/s12325-020-01354-6.
3. Shin, Hyun-Il, et al. “Therapeutic Effects of Clonazepam in Patients With Burning Mouth Syndrome and Various Symptoms or Psychological Conditions.” Scientific Reports, vol. 13, no. 1, Springer Science and Business Media LLC, May 2023. https://doi.org/10.1038/s41598-023-33983-6.
4. Salari, Pooneh. “Systematic Review of Modulators of Benzodiazepine Receptors in Irritable Bowel Syndrome: Is There Hope?” World Journal of Gastroenterology, vol. 17, no. 38, Baishideng Publishing Group Inc., 2011, p. 4251. https://doi.org/10.3748/wjg.v17.i38.4251.
5. Aulakh, G., et al. “Retrograde Amnesia After Intravenous Sedation and General Anaesthesia in a Dental Hospital.” British Journal of Oral and Maxillofacial Surgery, vol. 56, no. 7, Elsevier BV, Sept. 2018, pp. 632–35. https://doi.org/10.1016/j.bjoms.2018.06.017.
6. Crowe, Simon F., and Elizabeth K. Stranks. “The Residual Medium and Long-term Cognitive Effects of Benzodiazepine Use: An Updated Meta-analysis.” Archives of Clinical Neuropsychology, vol. 33, no. 7, Oxford UP (OUP), Dec. 2017, pp. 901–11. https://doi.org/10.1093/arclin/acx120.