Can Diazepam Help With Pain?
Diazepam, a type of benzodiazepine, is often used in the management of various pain conditions. It works by calming the nerves and brain, which can help to alleviate pain. However, it's important to note that diazepam is typically used as part of a comprehensive pain management plan and not as a standalone treatment. Always consult with a healthcare professional before starting any new medication.
What is Diazepam?
Diazepam, sold under the common prescription brand names of Valium or Valrelease, is a medication primarily used to relieve anxiety, treat acute epilepsy, induce sedation and address symptoms of alcohol withdrawal, including anxiety and agitation. It is a benzodiazepine sedative with a risk of developing tolerance to its effects and develop breathing problems.
Diazepam is also used in combination with other medications to address musculoskeletal symptoms, including muscle spasms, rigidity or dyskinesia syndromes [1].
How Does Diazepam Work?
Diazepam works by enhancing the effect of a neurotransmitter in the central nervous system called gamma-aminobutyric acid (GABA) [2]. GABA is the major inhibitory neurotransmitter in the brain, and when it binds to its receptors, it reduces neuronal excitability, leading to a calming effect [2].
Diazepam increases the conductance of GABA-A channels, a specific sub-type of GABA receptors activated by low concentrations of GABA. GABA-A activation leads to an increase in the influx of chloride ions into the neuron, which inhibits neuronal activation [3]. This results in the various therapeutic effects of diazepam, such as reducing anxiety, relaxing muscles, and controlling seizures by reducing activity in the amygdala and limbic system [4, 3].
Studying whole-brain neurobiology, it was suggested that diazepam increases the connectivity between different brain regions [4]. This effect was similar to that of other CNS depressants, including alcohol, but it contrasted with a reduction in whole-brain connectivity after taking CNS stimulants [5]. Hence, many of the anxiolytic and sedative properties of diazepam can be attributed to changes at the cellular and whole-brain levels.
But how does this relate to pain processing?
Does Diazepam Help with Pain?
Diazepam is primarily used for its sedative, anxiolytic, and muscle relaxant properties. However, reducing neural activation can also be beneficial to reducing the activity of nociceptors - neurons specialized for carrying pain information - and activity in brain centers processing pain, such as the thalamus and periaqueductal gray region in the brainstem [6]. This property would offer pain relief in acute and chronic pain conditions.
In the following sections, the benefits of diazepam in distinct types of pain will be discussed.
Neuropathic Pain
Neuropathic pain is pain arising from damage to a nervous system component, such as an impinged nerve, whiplash, or spinal cord injury. One study in rats found that injecting diazepam into the spinal cord cavity reduced the mechanical and thermal pain sensitivity in a model of neuropathic pain. This was attributed to a reduction in the immune response to the injury, which reduced aberrant neural activity following the nerve injury. Therefore, this study supports the off-label use of diazepam for neuropathic pain [7].
Post-Herpetic Neuralgia
Post-herpetic neuralgia is a subtype of neuropathic pain caused by infection of the herpes zoster virus. It is described as itching, burning, and more sensitive to usual stimuli, such as clothes on the skin [8].
Diazepam has also been found to be effective in managing pain related to herpes zoster. Older patients who received an intramuscular diazepam injection for three consecutive days experienced effective pain management and improved quality of life compared to those who received a placebo [9]. The rate of pain alleviation was highly heterogeneous, ranging from 10% to 66% pain relief on, but it was not associated with any adverse reactions. Therefore, this study would support the use of diazepam in post-herpetic neuralgia and herpes zoster infection pain.
Lower Back Pain
Lower back pain is a prevalent issue in diverse populations, affecting over 8% of the population [10]. One can experience both acute back pain and chronic back pain, and these would require different pain medicines.
One study from 2023 found that diazepam could reduce lower back pain in the acute emergency ward within 60 minutes, indicating that diazepam can be used to manage lower back pain [11]. Similar to previous applications of diazepam for pain conditions, its use is not FDA-approved. No study to date has looked at the effects of diazepam on chronic lower back pain.
Female Pain
Pain experienced by females is somewhat different to that experienced by men. Women may be more sensitive to pain, and currently available analgesic drugs may not be as effective in women as in men.
Diazepam has been used to address pelvic floor pain, where it has been administered directly into the vagina. 62% of women reported an improvement in their pain symptoms, which supports the use of diazepam in urogenital pain conditions [12].
Diazepam Can Make Pain Worse
However, diazepam's role in pain management is not always positive or beneficial. Diazepam has been found to antagonize the effects of morphine, a commonly used analgesic drug used for moderate to severe pain. This was seen when doses as low as 0.5mg/kg of diazepam were used.
In some cases, it has been found to reduce the analgesic effects of other drugs. For instance, diazepam was shown to antagonize the analgesic action of morphine [13, 14, 15]. This means that you would need a higher dose of morphine to alleviate your pain, increasing the risk of possible side effects. These may include common side effects of benzodiazepines, including difficulty breathing, respiratory depression, low blood pressure, brain fog, or impaired coordination.
Summary: Can Diazepam Help With Pain?
To summarise, there is evidence to support that diazepam is effective at reducing inflammation in neuropathic pain, herpes zoster neuralgia, lower back pain, and even urogenital pain, including pelvic floor pain. Nonetheless, whether it is as effective a steroidal anti-inflammatory drugs or over the counter analgesics remains to be investigated. Make sure to seek medical advice if you experience pain, and do not take diazepam without a prescription. Consult your healthcare professional about any concurrent drugs you are taking to avoid drug interactions.