Feeling anxious or concerned on occasion is perfectly normal. However, when these feelings become excessive and persistent, it can affect a patient’s ability to execute everyday tasks and make it more challenging to control current health problems. Experiencing a physical injury can, at times, lead to the development of anxiety with symptoms ranging from palpitations, shortness of breath, or the feeling of losing emotional control. Even a mental injury can incur other unexpected psychological conditions. The Workers’ Compensation Research Institute (WCRI) explains that over 58 percent of injured workers with a mental injury such as PTSD have one or more secondary psychiatry diagnoses. If untreated, conditions such as anxiety may lead to other health issues such as insomnia, restlessness (inability to rest or relax), muscle tension, and fatigue.
It is not uncommon for patients who suffer a physical injury to develop anxiety or related symptoms. Studies have found that injured workers who experience anxiety and panic-related symptoms, precede the onset of pain. When a patient experiences both anxiety and pain, it’s possible that both conditions can exacerbate the other. When handling anxiety and pain, the treatment approach should be specific to the individual patient. It also requires caution and deep knowledge of both conditions.
One group of medications commonly used to treat anxiety in patients who suffer from chronic pain is benzodiazepines, sometimes referred to as “benzos”. These medications have sedative and anxiolytic properties that aide in alleviating anxiety symptoms, insomnia, and muscle tension. Some of the commonly prescribed benzodiazepines include alprazolam (Xanax), clonazepam (Klonopin), and diazepam (Valium).
Chronic pain is frequently treated with opioids, which hold many potential adverse effects in common with benzodiazepines. The combination of opioids and benzodiazepines without proper medical monitoring can result in adverse effects such as sedation and respiratory depression, which could lead to death.
Side effects associated with benzodiazepines include a reduced ability to drive, loss of memory, impaired body balance or coordination, slow speech, and weakness. If taking a benzodiazepine, it is essential to exercise caution when performing tasks requiring high attention levels.
Overall, benzodiazepines are not considered a first-line option to treat anxiety. Several other options, including antidepressants, are preferred over benzodiazepines and have fewer risks when used in combination with opioids. There are, however, circumstances where benzodiazepines can offer specific benefits to chronic pain patients that other antidepressants can’t.
Benzodiazepines can be highly effective for patients experiencing chronic pain accompanied by insomnia and muscle tension. These medications can significantly improve sleep quality by increasing sleep time and reducing the time to fall asleep. They can also relax the muscles, therefore reducing muscle tension. The safe use of opioids and benzodiazepines can help to improve patients’ outcomes when safely prescribed and adequately monitored.
Like opioids, benzodiazepines have the potential for abuse and dependence. It is vitally important to provide patient education and closely monitor these patients, especially those with a history of substance abuse. It is crucial to encourage all patients to be honest with prescribers and inform them of all current medications and any substance use history, including alcohol and illicit drugs. Open communication between patients and health care providers can help ensure that patients receive high-quality treatment, avoid or reduce side effects, and receive the most benefit from their medications.
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