What is the recommended dose of diazepam (Benzodiazepine) for back pain?

From the Guidelines

Diazepam should not be used as a first-line treatment for back pain due to its high risk of dependence, tolerance, and side effects, and should only be considered for short-term relief (less than 2 weeks) at a dosage of 2-10 mg taken orally 2-4 times daily as needed. When prescribed, it's essential to weigh the potential benefits against the risks, considering the patient's medical history and current health status 1. The use of diazepam for back pain is generally not recommended due to its potential for central nervous system adverse events, such as somnolence, fatigue, and lightheadedness, as well as its risk of addiction, abuse, and overdose 1.

Some key points to consider when deciding on the use of diazepam for back pain include:

• Non-medication approaches like physical therapy, gentle exercise, and heat/cold therapy should be tried first 1
• Non-opioid analgesics such as acetaminophen or NSAIDs should be considered before muscle relaxants 1
• Muscle relaxants that aren't benzodiazepines (like cyclobenzaprine or methocarbamol) are generally preferred when medication is necessary for muscle spasms 1
• Diazepam works by enhancing the effect of GABA, an inhibitory neurotransmitter in the brain, which produces muscle relaxation but also causes sedation, cognitive impairment, and can lead to physical dependence even with short-term use 1

It's crucial to prioritize non-pharmacological interventions and to carefully select patients who may benefit from diazepam, closely monitoring them for potential adverse effects and adjusting treatment as needed 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Dosage should be individualized for maximum beneficial effect. ... Adjunctively for Relief of Skeletal Muscle Spasm. 2 mg to 10 mg, 3 or 4 times daily The recommended dose of diazepam for back pain, specifically for the relief of skeletal muscle spasm, is 2 mg to 10 mg, 3 or 4 times daily 2.

• The dosage should be individualized for maximum beneficial effect.
• The dose may be increased cautiously to avoid adverse effects.

From the Research

Diazepam Dose for Back Pain

• The recommended dose of diazepam for back pain is not explicitly stated in the provided studies, but its efficacy in treating back pain is discussed.
• According to the study 3, diazepam 5 mg was given to patients as 1 or 2 tablets every 12 hours as needed for low back pain, in addition to naproxen 500 mg twice a day.
• The study 3 found that diazepam did not improve functional outcomes or pain compared to placebo when added to naproxen for acute low back pain.
• Another study 4 compared the efficacy of seven skeletal muscle relaxants, including diazepam, and found that none of them improved outcomes more than placebo in patients with acute low back pain.
• The study 5 mentions that diazepam is effective in single or intermittent dosage, but does not provide specific dosage recommendations for back pain.

Efficacy of Diazepam for Back Pain

• The study 3 suggests that diazepam is no better than placebo when added to naproxen for acute low back pain.
• The study 4 found that diazepam did not improve outcomes more than placebo in patients with acute low back pain.
• The study 5 mentions that benzodiazepines, including diazepam, have a therapeutic value in a wide range of conditions, but does not provide specific evidence for their efficacy in treating back pain.

Comparison with Other Treatments

• The study 6 compared the efficacy of cyclobenzaprine 2.5, and 10 mg with placebo in patients with acute musculoskeletal spasm, and found that cyclobenzaprine 5 mg was as effective as 10 mg, with a lower incidence of sedation.
• The study 7 found that paracetamol did not affect recovery time compared to placebo in patients with low-back pain.