Detailed guides to painful problems, treatments & more

Benzodiazepine withdrawal syndrome 

 •  • by Paul Ingraham
Get posts in your inbox:
Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

I’d like to highlight a recent update to my collection of surprising causes of pain. Unfortunately, I have a lot of tragic personal experience with this topic: I have been addicted to benzos (more or less an medical accident), I have suffered grievously in withdrawal, and I have probably also suffered long term consequences. So the topic is close to my heart.

The benzos, Valium and many others, are potent tranquilizers, which sedate us by simulating a flood of an important neurotransmitter that is one of the body’s built-in sedatives. We can quickly develop powerful physical dependence on benzos, and rushed withdrawal is notoriously brutal. Withdrawal symptoms can even develop while we are still taking the drug, going a little bit into withdrawal before the next dose, which basically causes erratic and minor but frequent withdrawal symptoms.

In benzo withdrawal, you are the opposite of tranquilized: you’re anti-tranquilized. Huge chunks of your biology are way too excitable. The list of potential side effects is endless — benzo withdrawal is notorious for the freakish variety of symptoms it causes — but they all revolve around a strong theme of jittery misery, like being over-caffeinated but more extreme. Sensory distortion in general is the rule, and everything hurts more than it should.

And, in some people, for unknown reasons, withdrawal symptoms are long-term. It’s unclear what the mechanism for this persistence is, but it’s likely that the ferocity of withdrawal results in a poorly calibrated pain system (sensitization), which is a tough neurological tailspin to pull out of. Another way of putting it is that withdrawal is basically so surreal and traumatic that it can permanently disrupt our nervous system’s ability to interpret stimuli, especially threatening stimuli, leading to long-term erratic false alarms.

Benzos are extremely common drugs, and routinely taken by millions of people with virtually no awareness of the risks. I suspect that mild benzo withdrawal syndrome is surprisingly common, usually undiagnosed, one of the many unsuspected factors contributing to the epidemic of puzzling chronic pain.