Phenobarbital versus clonazepam for sedative-hypnotic taper in chronic pain patients. A pilot study.
A randomized, double-blind controlled trial is reported comparing phenobarbital and clonazepam for the purpose of sedative-hypnotic taper in inpatients with chronic, nonmalignant pain. After receiving the Minnesota Multiphasic Personality Inventory (MMPI) and a standardized psychiatric diagnostic interview, patients' baseline sedative-hypnotic use was assessed over 48 hours. Baseline use was converted into phenobarbital or clonazepam equivalents and administered in four doses daily using a blinded liquid pain cocktail. Baseline dose was maintained for two days and then tapered by 10% per day. Over the first week of taper, differences in mean and maximum Beck Anxiety and Benzodiazepine Withdrawal scores were not significant. However, when scales 1, 3, or 8 of the MMPI were taken as covariates, differences on the Withdrawal Scale only increased to a trend level for mean scores and to a significant level for maximum scores. These findings support the superiority of benzodiazepines over barbiturates for sedative-hypnotic taper for symptoms of withdrawal but not of recurrent or rebound anxiety.
Sullivan
M
M
Department of Psychiatry and Behavioral Science, University of Washington, Seattle.
Toshima
M
M
Lynn
P
P
Roy-Byrne
P
P
D000328:Adult; D001008:Anxiety Disorders / Q000139:chemically induced / Q000175:diagnosis; D002908:Chronic Disease; D002998:Clonazepam / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006760:Hospitalization; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D008950:MMPI; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy*; D010634:Phenobarbital / Q000627:therapeutic use*; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000517:prevention & control*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000188:drug therapy*
D006993:Hypnotics and Sedatives; D002998:Clonazepam; D010634:Phenobarbital