Body Aches in Benzodiazepine Withdrawal
Yes, body aches and muscle pain are recognized symptoms of benzodiazepine withdrawal. Specifically, muscle cramps, muscular pain and stiffness, and myalgias are documented manifestations when benzodiazepines are abruptly discontinued after prolonged use.
Evidence for Musculoskeletal Symptoms in Benzodiazepine Withdrawal
Muscle cramps are explicitly listed as a withdrawal symptom when benzodiazepines are discontinued after long-term ICU use, alongside anxiety, agitation, tremors, headaches, sweating, insomnia, nausea, vomiting, myoclonus, hyperactive delirium, and occasionally seizures 1.
The broader withdrawal syndrome includes muscular pain and stiffness as characteristic features, occurring alongside sleep disturbance, irritability, increased tension and anxiety, panic attacks, hand tremor, sweating, difficulty concentrating, nausea, weight loss, palpitations, headache, and perceptual changes 2.
Muscle aches (myalgias) and weakness are specifically documented as part of the withdrawal symptom constellation that should be monitored during benzodiazepine tapering 3, 4.
Clinical Context and Symptom Patterns
The withdrawal syndrome typically manifests as a cluster of symptoms rather than isolated complaints. In one survey of 1,207 individuals, the mean number of withdrawal symptoms reported was 15 out of 23 possible symptoms, with 6% experiencing all 23 listed symptoms 5. This underscores that body aches rarely occur in isolation but are part of a broader withdrawal picture.
Withdrawal timing depends on the benzodiazepine's half-life: short-acting agents produce symptoms peaking within 1-2 days, while long-acting agents like diazepam may not peak until 5-12 days after discontinuation 3.
Management of Musculoskeletal Withdrawal Symptoms
For muscle aches specifically, NSAIDs or acetaminophen can be used for symptomatic management 3. However, the primary strategy is to slow or pause the taper when withdrawal symptoms emerge, as the taper rate must be determined by the patient's tolerance, not a rigid schedule 3, 4.
Gabapentin may help mitigate withdrawal symptoms including musculoskeletal complaints, starting at 100-300 mg at bedtime or three times daily, increasing by 100-300 mg every 1-7 days as tolerated 3.
Critical Safety Considerations
Abrupt discontinuation should never occur, as benzodiazepine withdrawal carries greater risks than opioid withdrawal and can cause seizures and death 3, 6. The recommended approach is gradual tapering with reductions of 10-25% of the current dose every 1-2 weeks for patients on benzodiazepines less than one year, or 10% of the current dose per month for long-term users 3.
Body aches signal the need to slow the taper further - they are not symptoms to simply "push through" but rather indicators that the nervous system requires more time to readapt 3, 4.