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Conservative Treatment of Back Pain:
Muscle relaxanats and benzodiazipnes are often used in the non-operative management of sciatica and non-specific low back pain. In fact, a 2003 Cochrane review concluded that muslce relaxanats were effective in the management of non-specific low back pain. However, a recent analysis of randomized trials reported little efficacy or only minor benefits with the use of benzodiazapines in treatment of low back pain.
A recent prospective, randomized, placebo-controlled, double-blinded trial conducted in Germany that enrolled a total of 60 patients found that the use of diazepam was equivilant to placebo in the reduction of distance of referred pain at day 7 of treatment. Diazepam was also noted on average to increase the length of stay of those patients hospitalized by 2 days (median hospital days of 8 for placebo versus 10 for diazepam), and the probablility of pain reduction on a visual analog scale by more than 50% was twice as high in the placebo group (p< 0.0015). Placebo reduced the patients pain more than diazepam.
Though the sample size was small; this study should really make one reevaluate the use of diazepam in the treatment of back pain. Early movement and discouraging bed rest have been associated with decreased back pain, so one mechanism by which benzodiazepines may make things work is by causing enough sedation to prevent early movement.
References
Brotz D, Maschke E, Burkard S, Engel C, Manz C, Ernemann U, Wick W, Weller M: Is there a role for benzodiazepines in the management of lumbar disc prolapse with acute sciatica? Pain 2010.