Alternatives to the Benzodiazepine Barb

by Christina Lasich, MD Health Professional

Quite a few people with chronic pain use benzodiazepine medications like Xanax, Valium, Ativan, and Klonopin. These medications lure people with the promise of relaxation; however, once hooked, it is difficult to shake loose from the benzodiazepine barb. Not many people realize the downside of these types of chemicals which include: confusion, distortion, forgetfulness, depression, tolerance, dependency, and rebound anxiety. Over time the barb digs in deep. Alternatives to benzodiazepines should be considered before becoming endlessly hooked.

One primary reason those with chronic pain use benzodiazepines is to treat muscle spasms. Increased tension can lead to increased pain; but, rebound anxiety created by benzodiazepines can also lead to increased pain as the medication effects wear off. Some alternative muscle relaxants might actually be a better solution for painful muscle spasms. One frequently overlooked medication is called Baclofen. This medication is not only useful to reduce spasticity, but it may also help reduce pain because it stimulates natural pain relieving pathways in the nervous system called the GABA receptors. Frequently used to treat the spasticity from brain and spinal cord injuries, Baclofen should be considered a first-line treatment in chronic pain patients as well. Another alternative to benzodiazepines is called Zanaflex. This medication is a true muscle relaxant because it reduces increased nerve signals from directly stimulating the skeletal muscles. Zanaflex calms the muscle activity without the risk of depression, anxiety, tolerance, dependency and addiction. Speaking of dependency and addiction, some non-benzodiazepines also used to treat muscle spasms have a pretty strong hook as well, namely Soma and Flexeril. Just beware, not all alternatives to benzodiazepines are without problems. If muscle spasms are a problem, trying an alternative to a benzodiazepine could be the better option.

Another reason people use benzodiazepines is to relieve anxiety. Feelings of anger, fatigue, hopelessness, fear, and depression all add up to anxiety. Short-term treatment with a benzodiazepine might be very appropriate; but eventually, these chemicals create so much distortion that life becomes more scattered and stressful than before. Many experts actually prefer to recommend mood stabilizers like Ambilify and Seroquel or an anxiolytic like Buspar for long-term treatment of anxiety. Benzodiazepine's siren song of relaxation is not usually the best long-term solution.

People also use benzodiazepines to solve insomnia. This solution can ultimately destroy sleep over a period of time through the development of tolerance and rebound insomnia. Instead, the alternatives are much better long-term solutions for insomnia. Two of the alternatives are actually anti-depressants. Trazadone is one possible alternative. And Elavil is another possible alternative. Used at low doses, both can help to restore sleep, not destroy it. Another alternative treatment for insomnia is Neurontin. Interestingly, both Elavil and Neurontin can also help relieve pain. So, both should be considered the best alternatives for someone who has chronic pain and insomnia. With better alternatives, a benzodiazepine may not be necessary to treat insomnia.

Whether muscle spasms, anxiety or insomnia are the problem, benzodiazepines may not be necessary and could cause even more problems. The benzodiazepine barb is fraught with nothing but trouble if one is hooked for too long. The initial euphoria of relaxation slowly wanes into feelings of anxiety, depression, confusion, and distortion. Alternatives medications provide a way to avoid this rollercoaster of benzodiazapine dependency and the benzodiazepine barb.

Christina Lasich, MD
Meet Our Writer
Christina Lasich, MD

Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.