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Benzodiazepines May Be Worse Than Opioids: Negative Medication Effects in Severe Chronic Pain

Gauntlett-Gilbert, Jeremy PhD; Gavriloff, Dimitri PGDip (Psych); Brook, Peter MBBS

doi: 10.1097/AJP.0000000000000253
Original Articles

Objectives: Opioid prescription for noncancer pain is increasing in Europe and the United States. Research and guidance have focused on the potential for dependency and medical side effects with high doses. In contrast, benzodiazepines have received little attention in the chronic pain literature, despite evidence for dependency and cognitive impairment in long-term use. We aimed to examine the relationship between these classes of medication use, mood, and functioning.

Methods: This cross-sectional study included patients (N=229) with disabling chronic pain who were about to start intensive pain rehabilitation. They completed self-report measures of mood, functioning, and responses to pain. We examined each patient’s medication use and calculated a single morphine equivalent (ME) dose per person, and a similar diazepam equivalent (DE) dose. We examined the relationship between drug dose, mood, and functioning.

Results: Higher DE doses were associated with worse outcomes in most domains. Higher ME doses were more narrowly associated with worse functioning. There was no evidence for any benefit of these drugs; higher doses were not associated with less pain, fear, or disability. Higher ME doses were not more problematic, contrary to our predictions. The combination of opioids and benzodiazepines was associated with particularly poor outcomes for mood.

Discussion: This study is the first to examine both opioid and benzodiazepine use together in chronic pain. We found the anticipated negative effects of opioid medication, and particularly consistent associations between benzodiazepine use and poor well-being. Future guidance on chronic pain prescription should focus on restricting benzodiazepine use.

*Bath Centre for Pain Services, Royal National Hospital for Rheumatic Diseases

Department of Psychology, University of Bath, Bath, UK

Author contributions: J.G.-G. had the idea for the study, led on writing the paper, and bears overall responsibility for the data. P.B. provided expert commentary on methodological and clinical aspects of medication issues. D.G. wrote sections of the paper and contributed to data analysis. All authors discussed the results and contributed to the manuscript.

Supported by the Royal National Hospital for Rheumatic Diseases NHS Foundation Trust, Bath, BA1 1RL, UK. The authors declare no conflict of interest.

Reprints: Jeremy Gauntlett-Gilbert, PhD, Bath Centre for Pain Services, Royal National Hospital for Rheumatic Diseases, Bath BA1 1RL, UK (e-mail:

Received December 1, 2014

Received in revised form December 28, 2015

Accepted April 21, 2015

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