How/why do benzodiazepines relieve symptoms?

[boulder]

This is a question that has been puzzling me for some time. First, here are some of my personal experiences with benzodiazepines (if you wish to skip to them, my more general questions are at the end of this post):

I was prescribed benzodiazepines (first diazepam [Valium], later switching to clonazepam [Klonopin]) for use several times a day, and took them as prescribed for several years (I absolutely do not recommend this. Just this year I slowly tapered off of them, which was pretty unpleasant at times). I discovered what many of you probably already know: that long-term, frequent use of benzodiazepines is not effective in treating CPPS. Tolerance simply develops too quickly to make this a viable treatment option, and there is the further complication of physical dependence.

However, a recent experience got me thinking about benzodiazepines again. I was having a very painful flare-up in symptoms, and I had a lot of activity planned for the next day, so I took diazepam before bedtime to break the flare. I started to feel symptom relief within an hour of taking the diazepam, and upon waking the next morning, found myself completely (or almost completely) free of all my chronic prostatitis / chronic pelvic pain syndrome symptoms (listed in my signature below). This remarkable symptom relief slowly faded over the next several days, and in fact, I even experienced a spike in symptoms in the subsequent several days following the period of symptom relief. The relief I got from taking a benzodiazepine was brief (though I certainly did appreciate it), followed by an uptick in symptoms, and, as I understand it, can only be used on rare occasions (as again, the problems of tolerance and dependence arise).

So benzodiazepines are less than ideal for occasional symptom relief, and are certainly not suited to frequent, long-term use. However, bearing this in mind, the symptom relief they can produce for very a limited time is dramatic. This brings me, finally, to my questions, which are short, but by no means simple:

What are the mechanisms by which benzodiazepines relieve chronic prostatitis / chronic pelvic pain syndrome symptoms?

What changes do benzodiazepines make to the physiology of chronic prostatitis / chronic pelvic pain syndrome patients, and is there any way to effect these same changes by some other means with greater permanence and/or fewer drawbacks?

My thanks in advance to anyone who tackles these questions!

PS: I don't mean to generalize too much- I'm not sure that all chronic prostatitis / chronic pelvic pain syndrome sufferers get symptom relief from benzodiazepines, but I think I am correct in saying that a fair number of us do.

[webslave]

Benzos are skeletal muscle relaxants as we all know, as well as being anxiolytic. They are not meant to be used long term.

You could try cyclobenzaprine aka Flexeril:
http://pubmed.ncbi.nlm.nih.gov/18711953

There is a study showing that benzos + alcohol gives a strong myorelaxant effect, but benzos come with a warming NOT to take alcohol at the same time:
http://pubmed.ncbi.nlm.nih.gov/15907229

Here's a novel suggestion: Valerian
http://pubmed.ncbi.nlm.nih.gov/15334039
http://www.aafp.org/afp/20030415/1755.html

[boulder]

Thank you very much for your answer, Webslave! I am currently taking another tricyclic antidepressant, amitriptyline (Elavil), that doesn't seem to do much for me, but I will definitely talk to my doctor about cyclobenzaprine, as it has muscle relaxant qualities that amitriptyline does not, according to the links you provided.

I have also tried carisoprodol (Soma) and metaxalone (Skelaxin), both centrally-acting muscle relaxants, but they did not relieve any of my symptoms. I'm assuming it must be the different mechanisms of action that account for their lack of efficacy.

It's interesting that you raise the subject of ethanol increasing the muscle relaxation caused by diazepam. In my case, while I have found diazepam to provide much symptom relief, I have not found the same to be true of ethanol. In fact, drinking alcohol often seems to make my symptoms worse.

I read on the Wikipedia link you provided that valerian binds to the same sites as benzodiazepines on GABA A receptors which makes it sound promising. I will be sure to ask my doctor about valerian as well.

[Edit: it appears that carisprodol may be a GABA A receptor agonist as well, and so is ethanol, so I guess not all GABA A receptor agonists are created equal...]

[BrettP]

I'm torn on benzos. At first they were very helpful. But I believe I have been having interdose withdrawals for the past year which I believe has kept me sick. In fact I was taking small amounts of Xanax and valium. I have weaned off Xanax and am going down to 5 mgs of Valium at one gram a week. And then pull the taper out longer going down .5 mg per week. My guess is that by the time I'm off these pills I will start true recovery. The pills are the only thing different since start point and end point that has been going on and not changed.

[BrettP]

Completely off the Xanax for one week now, smoking limited to when I drink, eating normally, feel like a new man. I'm slowly tapering off the diazepam. Get this, NO pain, NO urinary symptoms. In fact I find myself going to the restroom out of habit even though I don't even have to go! My bowel problems? Cleared up. Granted, it also hasnt been as stressful at work, and I still have some weak stream, but I feel worlds of difference in just the past couple weeks... like a new man. Like I have been born again. And there has been TWO major stressors come down on me in the last week!

I strongly urge anyone reading this... STAY OFF THE BENZOS. They are for short term use only, do not become long term dependent on them, especially Xanax. The short half life of the drug causes uneven blood plasma concentrations and you will get interdose withdrawal syndrome from it.

If you are on it, and getting these withdrawal symptoms, you need to taper off of it using valium, and slowly reduce that to be completely free of these medications.

[BrettP]

Wanted to mention this as well. My mindset is COMPLETELY different since I stopped smoking and stopped taking the Xanax. Also was able to ejaculate four times in 5 hours. Ate an entire large pizza, topped it off with 6 beers, and still NOTHING. Normally I would be curled into a ball of pain at this point. I really feel like I'm on to something here. Definitely worth a try if you havent already tried getting off these god damn pills.

[webslave]

Nobody should be taking benzos continuously.

[carld]

Also was able to ejaculate four times in 5 hours. Ate an entire large pizza, topped it off with 6 beers, and still NOTHING. :

Easy tiger...

I agree benzos are for flair breaking at that moment to calm you and stop the vicious cycle or catastrophic thinking by easing anxiety...

I took benzos for two months as needed and I remember just stopping...It was the biggest mistake of my life...The withdrawal was really bad...Not a smart thing to do.

[BrettP]

Each time I taper down from one plateau to the next I get symptomatic. I'm on 7.5 my right now will continue at this level until withdrawal symptoms stop. And then proceed to 5mg. Worst mistake I ever made was taking them for too long. Just want to male sure everyone is ware of the long term effects and how it can exacerbate this condition.

[papichullini]

Definitely worth a try if you havent already tried getting off these god damn pills.

Sorry I'm a bit lost... You just stop taking that pills and you feeling 100%? Or you taking anything specially good for you?

Thanks.

[BrettP]

I was referring to short acting benzos. Xanax. Tapered off that. Feel like a new man. Used diazepam to taper off Xanax. Was already taking Valium anyway. Now I'm going for complete cessation of benzos. Only problem is as your body gets used to less benzo it reacts. But once that reaction stops you feel better mentally and physically. I'm at my lowest dose ever. It just can't be a coincidence.

[jhferry]

I have a prescriptions for Clonezepam but its only .05 twice a day. I get headaches, prostatitis and anxiety so its a miracle for me. I go through about 2 really bad flare ups a year but I'm wondering what the negative health effects are? Besides addiction I mean.

[Clay]

I'm somewhat defensive about Xanax. It literally saved my life decades ago before I was treated with CBT for my panic disorder. I've been on and off it for decades.

I can't take it with vicodin and play tennis. It causes the ball to disappear from sight for critical nanoseconds. My pain is worse those days. Other days I take both narcotics and Xanax - plus Lyrica, and Elavil at night. I haven't changed my dose in 18 months, and it is still as effective. It isn't completely effective, but Xanax is the best tool in my box.

Don't get me wrong, I'm on my way at long last to a pain specialist to try to get on to better meds. I just haven't found Xanax to be a monster at all.

[webslave]

I just haven't found Xanax to be a monster at all.

Nor have I, but it's genetics. Just as any accredited quercetin product only helps ~70% of men, so too with other drugs; we don't all react the same way to drugs and nutraceuticals.

[boulder]

I've been doing some reading about diazepam to try to understand how it achieves its effects. It's interesting to realize that though diazepam has been used for over 40 years, it was only in the 2000s that scientists were able to pinpoint clearly how it functions (after genetic engineering allowed them to create lab animals lacking specific GABA A receptor subunits)!

This paper says that diazepam's anxiolytic (anti-anxiety) effects are mediated by alpha 2 GABA A receptors: http://pubmed.ncbi.nlm.nih.gov/11021797 and this one says that diazepam's myorelaxant (muscle relaxant) effects are mediated by the very same receptors (as well as alpha 3 GABA A receptors, possibly, at high doses), so it's interesting to note that, at least in this case, the anxiety/muscular tension relationship seems to exist on a molecular level: http://pubmed.ncbi.nlm.nih.gov/11179437

Both papers suggest that future drugs could be targeted at alpha 2 GABA A receptors. However, as my doctor joked when we discussed my experience with benzodiazepines, finding something that had the same effects but without the disadvantages of tolerance, etc. wouldn't just be of use to chronic prostatitis / chronic pelvic pain syndrome patients- it would be the biggest-selling drug ever! This points out both how difficult such a thing must be (if it were easy, someone would have done it already) and how great the demand would be.

To jump back a second, if we assume that diazepam's muscle relaxant qualities are what relieves chronic prostatitis / chronic pelvic pain syndrome symptoms, then exploring other muscle relaxants makes sense for someone like me who gets relief from diazepam. It would be interesting to see if any symptom relief comes from other muscle relaxants with different mechanisms of action (as I said, I haven't found one yet, but I'll report back to the forum as I try different things). If other muscle relaxants don't work, I'm thinking that would suggest that there is something important about the specific mechanism of action?

Well, I don't mean to generalize too broadly from my own case here (as Webslave just mentioned, not everyone reacts the same to the same drugs) or get too far-out in my thinking (I'm not holding my breath for some kind of tolerance-proof benzo), just thinking out loud...