I was correctly diagnosed with idiopathic small fibre peripheral neuropathy following numerous tests and a skin biopsy. The tingling and burning pains progressed within 4 months up to and above the knees. This raised my level of anxiety - things getting worse but no diagnosis.

My doctor suggested taking Citalopram and gave me a few Diazepam as a short term back up to reduce the anxiety. Within 20 minutes of the first Diazepam(not the best drug to start taking) the burning significantly reduced. I discussed this effect with a neurologist whose conclusion was that a significant level of the burning was caused by the anxiety not the PN as the Diazapam should not reduce neuropathic pain.

As the Citalopram has started to get into the system the burning has reduced.
Does this ring any bells with anyone?

Antidepressants work on the mechanisms of central pain, which may be where some or most of your pain resides.

Diazepam works on GABA receptors, and also has some antiseizure properties. Antiseizure drugs may help with nerve pain. Here is an explanation of how this works...

first post on neurons:
http://neurotalk.psychcentral.com/post828704-7.html

second post with details on antiseizure drugs:
http://neurotalk.psychcentral.com/post829772-9.html

third post with details on Neurontin/Lyrica:
http://neurotalk.psychcentral.com/post829091-8.html

Some of the posters here have found that in the beginning, the benzos like diazepam work well, but slowly this effect fades, and then you become habituated to them instead. Getting off of them then becomes a very difficult thing, with slow tapers, that can last weeks to months.

Here is an article on GABA and pain. You can copy it and give to your doctor.
http://www.ncbi.nlm.nih.gov/pubmed/17175808

If you decide to use diazepam, I'd suggest medication holidays, or sporadic use. A day here or there, for very bad days. This will reduce the tolerance feature. What happens with drugs that affect neurotransmitters, is that they over time affect the receptors, and then the body tends to make MORE receptors and then the drug stops working as before and the patients then need a dose increase.

Also depending on your age, taking Benzos like diazepam, are metabolically difficult to clear, and pose problems for the elderly...build up in the system, which causes many other problems. The cut off here is around 55 or 60, unless you have decreased kidney functions earlier in life.

Some people have found diazepam too "harsh" (for lack of a better term right now). Same with alprazolam (a similar medication). If so, you can cut either into halves, or even quarters, with a pill cutter/splitter (NAYY).

Please be sure to read the drug information sheets that come with both medications (citalopram, diazepam) carefully, and retain them for future reference.

Doc

I have been having more severe pain in my legs lately, throughout the day, which is limiting, and had increased my use of oxycodone (the frequency, 2per day, 7.5 each, not the dosage ) just to allow me to get some housework etc. done. Along with the increased pain is an increase in muscle spasms and tremors. I have over the past month gotten into the habit of taking a 5mg Valium to help relax the muscles so I can get some decent sleep. Otherwise I suffer from restless legs and a feeling of being on the edge of a severe spasm. It is funny, the advanced SFN makes muscle spasms feel differently, all tight and twisted but not the sharp pain they used to cause. I do use Kirkman's magnesium cream.

To get to the point, is this use of Valium a problem and should I take a "holiday" from it? I took a week off from the oxycodone last month with no problem, but the pain wasn't this bad then either. I can't take oxy at night, it keeps me awake. I am not particularly worried about dependency issues as both pain and disability are going to increase over time, waxing and waning, but generally downhill. I am still fairly strong though and not wanting to add problems unnecessarily!

Thank you!

If you can stand a holiday, or a day off here and there, I'd do it.

All the medications we have that affect neurotransmitters, affect receptor concentration over time. The body tends to want to keep some receptors open, for sensory protection. It is a biological adaptation that evolved to allow us to flee, or fight, and to avoid pain.

So even if you have a life long need for a Benzo, you are going to slowly reach a dose where your kidneys cannot excrete it well, and it will build up in your system causing CNS depression and respiratory depression. (this is more common in the elderly and does not need high doses). This is why Benzos are no longer recommended for elderly patients.

Valium is a long acting Benzo. The only other longer acting one is Klonopin (clonazepam). Sudden withdrawal after long time everyday use of either, can result in seizures, even in people without epilepsy. Much of this risk is time dependent and dose dependent. So taking only when needed, will help prevent tolerance issues and need for higher doses. What I see in the general population with people on a Benzo (which is a controlled substance BTW), is that if they are maintained on it for a long time (because of special need), they can be caught short on a refill, lose them, get robbed, or a natural disaster interrupts their ability to get more, and then the sudden discontinuance becomes very serious. It is this that can be a serious medical consequence.

Ativan is a moderately long acting Benzo and Xanax is short acting.

Hi Susanne,

I don't know if I'd go so far as to say it's a 'problem' yet, but I have heard of people getting spasms/twitching after the intended effects of benzodiazepines have worn off (kind of like a hangover). As I was reading your post (before I got to the question above) this is what I was thinking.

If you think you can do without it for a time (couple weeks? ) I wouldn't think it would hurt to try a holiday. (If it can't hurt to try it, then it can't hurt to try it.) You might be able to determine if the increased pain is due to the diazapam, and modify accordingly (pill cutting/re-titrating is one possibility).

I've heard of more oxycodone than actually needed doing something similar in some cases (there's a syndrome, the name of which escapes me at the moment). If you're taking a splittable form (either oxycodone or 'percocet' but not Oxycontin) you might try that.

Doc

Also, if you have been using a Benzo regularly for a long time,
you'd have to do a taper type holiday. Say 1/2 the regular dose.

People on long term Benzos cannot stop cold turkey.

If you only take the Benzo here and there, skipping some days and not using high doses, you can probably do a complete day skip or two.

Seizures can occur in long time users, who withdraw suddenly.

Thank you Mrs. D! More than enough reason to get by without it more often than not. I have them primarily for muscle spasms, and secondarily for specific anxiety issues, when my kids are all miserable at once and complaining. (they are adults, i am not neglecting infants here!) Usually I do not use them, and months go by without requesting a refill, but I do hit these pockets of regular use.
The kidney build up is sobering. I am 50, but feel a lot older.

Should this be moved to the other question, and isn't one 5 mg. per day considered a small dose?

Yes, thanks, I moved the post.

5mg a day is not much at this point. It is a toss up whether you'd notice a holiday or not. But I suspect you will notice possible increased symptoms, but risk of seizures would be small.

Just about every poster here who took Benzos developed problems from them, over time.