Use of Benzodiazepines in Lower Back Pain

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Use of Benzodiazepines in Lower Back Pain

• Problem Based Learning, Oct 2008

2
Cochrane Systematic Review - 2003

• Muscle relaxants for non-specific low-back pain
• Thirty trials met the inclusion criteria
• 23 trials (77) were of high quality
• 24 trials (80) were on acute low back pain
• 4 studied benzodiazepines
• 11 non-benzodiazepines
• 2 antispasticity muscle relaxants
• in comparison with placebo

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Cochrane Systematic Review

• Results showed that there is strong evidence that
  any of these muscle relaxants are more effective
  than placebo for patients with acute LBP on
  short-term pain relief.
• The various muscle relaxants were found to be
  similar in performance.

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Cochrane Systematic Review

• Authors' conclusionsMuscle relaxants are
  effective in the management of non-specific LBP,
  but adverse effects require that they be used
  with caution. Trials are needed that evaluate if
  muscle relaxants are more effective than
  analgesics or NSAIDs.

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BestBets - 2005

• Use of muscle relaxants in acute LBP. Also
  benzodiazepines non- benzodiazepines.
• Following comment
• Many cope well with simple analgesics
• But many c/o spasmodic pain and stiffness
• Therefore logical argument for use of relaxants.

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BestBets

• The systematic review demonstrates that in RCTs
  and CCTs does appear to be a real benefit from
  use of muscle relaxants in acute and chronic
  settings.
• However, incidence of S/Es is considerable and
  their blanket use cannot be advocated.
• Remains up to treating physician to assess need
  for and potential risks in individual patients

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BestBets

• Clinical bottom line
• Muscle relaxants are effective in management of
  acute and chronic back pain.
• However, the incidence of side effects means that
  they must be used with caution.

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CKS (formerly PRODIGY)

• Discuss muscle relaxants in their guideline on
  lower back pain, this includes the following
  passage
• If analgesics fail to provide adequate relief,
  consider a short course of a muscle relaxant, on
  its own or together with an NSAID.
•  Several muscle relaxants have been studied in
  relation to lower back pain. Diazepam is usually
  first-line choice.
• Due to risk of dependency, recommended only for
  short courses