Alliance for Benzodiazepine Best Practices, Littleton, CO, USA.
Adv Ther. 2020 Jun;37(6):2604-2619. doi: 10.1007/s12325-020-01354-6. Epub 2020 May 6.
Controversy and uncertainty exist about the use of benzodiazepine receptor agonists (BZRAs) in pain management. This article curates available research to determine the appropriate role of BZRAs in the course of pain management, and how prescribers might address these challenges.
A narrative review was performed to determine the appropriate role of BZRAs in pain management and to develop practice recommendations. Publications were identified by a search of PubMed, references of retrieved reports, guidelines, and the author's personal files.
BZRAs were found to have analgesic benefit for two pain conditions: burning mouth syndrome and stiff person syndrome. Absence of research, heterogeneity of trials, and small sample sizes precluded drawing conclusions about efficacy of BZRAs for the other 109 pain conditions explored. Data supports the use of BZRAs to treat co-occurring insomnia and anxiety disorders but only when alternatives are inadequate and only for short periods of time (2-4 weeks). The utility of BZRAs is limited by loss of efficacy that may be seen with continued use and adverse reactions including physiologic dependence which develops in 20-100% of those who take these agents for more than a month.
BZRAs are often used inappropriately in pain management. Their initiation and duration of use should be limited to a narrow range of conditions. When prescribed for 4 weeks or more, patients should be encouraged to discontinue them through a supported, slow tapering process that may take 12-18 months or longer.
苯二氮䓬受体激动剂（BZRAs）在疼痛管理中的应用存在争议和不确定性。本文通过对现有研究进行梳理，以确定 BZRAs 在疼痛管理过程中的适当作用，以及如何解决这些挑战。
通过对 PubMed 进行检索，检索报告的参考文献、指南和作者的个人文件，以确定 BZRAs 在疼痛管理中的适当作用，并制定实践建议。进行了叙述性综述。
研究发现，BZRAs 对两种疼痛病症具有镇痛作用：灼口综合征和僵人综合征。对于其他 109 种探索的疼痛病症，由于缺乏研究、试验的异质性和样本量小，无法得出 BZRAs 疗效的结论。数据支持使用 BZRAs 治疗并存的失眠和焦虑症，但只有在替代治疗方法不足且仅使用短时间（2-4 周）的情况下。BZRAs 的效用受到限制，因为随着持续使用，其疗效可能会下降，并且会出现不良反应，包括生理依赖，在使用这些药物超过一个月的人中，有 20-100%会出现这种情况。
BZRAs 在疼痛管理中经常被不恰当地使用。其启动和使用时间应限于少数几种情况。当处方使用 4 周或更长时间时，应鼓励患者通过支持性、缓慢的减量过程停药，这可能需要 12-18 个月或更长时间。
