New healthcare advice: Benzodiazepines will not help low back pain

Australians seeking relief from low back pain are being urged not to use benzodiazepines (minor tranquilisers) as part of their treatment, according to recommendations released today by Choosing Wisely Australia.

Five new recommendations around pain management, including for low back pain and chronic non-cancer pain, have been developed by the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists.

These recommendations offer the latest evidence-based advice on tests, treatments and procedures that should be questioned by health professionals and consumers and form the basis of their discussions on pain management.

Dr Mick Vagg, pain medicine physician and Chair of the Faculty’s Professional Affairs Executive Committee said: “Low back pain is one of the most prominent pain conditions experienced by Australians. Up to 80% of people will experience low back pain at some point in their lives, with one in 10 being limited in their day-to-day activities and looking for relief.

“However, a recent review found there was no evidence to support people taking benzodiazepines as ‘muscle relaxants’ to relieve their low back pain, in addition to or instead of anti-inflammatory medicines.

“Like all drugs, there are risks associated with taking benzodiazepine including abuse, addiction, tolerance and overdose resulting in accidental death. We are urging healthcare providers and their patients to discuss the appropriateness of benzodiazepine use.”

New advice has also been issued on treating chronic non-cancer pain with opioids.

“Managing chronic pain is complex, but there is little evidence to support the use of opioids as the first or only treatment option,” Dr Vagg said.

“Most trials undertaken into their effectiveness in treating chronic non-cancer pain have been run for under 12 weeks and have shown only modest impact.

“In contrast, some people taking opioids for chronic non-cancer pain have experienced increased distress, poorer self-rated health, inactivity during leisure, unemployment, higher use of healthcare and lower quality of life.”

The five latest recommendations are:

1. Avoid prescribing opioids (particularly long-acting opioids) as first-line or monotherapy for chronic non-cancer pain.
2. Do not continue opioid prescription for chronic non-cancer pain without ongoing demonstration of functional benefit, periodic attempts at dose reduce and screening for long-term harms.
3. Avoid prescribing pregabalin and gabapentin for pain which does not fulfil the criteria for neuropathic pain.
4. Do not prescribe benzodiazepines for low back pain.
5. Do not refer axial lower lumbar back pain for spinal fusion surgery.

NPS MedicineWise Client Relations Manager Dr Robyn Lindner said: “These new recommendations will help health professionals discuss an appropriate pain management plan with their patients based on the latest evidence around the use of pain medications.”

Choosing Wisely Australia encourages people to ask questions around any test, treatment or procedure being recommended to them and offers a list of 5 Questions people can ask their doctor or other healthcare providers.

There have been 168 healthcare recommendations released through Choosing Wisely Australia by 35 colleges, societies and associations since the initiative launched in April 2015.

Full lists of recommendations are available at choosingwisely.org.au/recommendations.