Benzodiazepines, commonly known as “benzos,” are a class of psychoactive drugs prescribed for anxiety, insomnia, and some other medical conditions. They operate by enhancing the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABA_A receptor, which results in sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant properties.

Muscular Effects During Withdrawal

Benzo withdrawal symptoms can occur while still taking the drug (tolerance withdrawal), in-between doses (interdose withdrawal), and while tapering or off the medication. One of the less discussed but significant impacts of withdrawal is on the musculoskeletal system.

Benzodiazepine withdrawal can cause heightened muscle tension and spasticity. This occurs because benzos cause the GABA receptors to downregulate, and the body experiences a hyperexcitable state due to the reduced efficacy of GABAergic inhibition. This state can lead to muscle pain, burning, spasms, stiffness, twitching, and discomfort, often described by individuals undergoing withdrawal. Also, muscles may look the opposite of taut and appear flabby and slack, lacking tone.

Benzo Withdrawal And Mimicking Diseases

Benzodiazepine withdrawal can mimic a variety of muscular issues due to the central role of GABA neurotransmission in muscle control. Here are some conditions that the muscular symptoms of benzo withdrawal might resemble and be misdiagnosed as:

1. Fibromyalgia: This is characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues. The muscle pain, stiffness, and spasms experienced during benzo withdrawal can be similar to the symptoms of fibromyalgia.
2. Neuromuscular Hyperexcitability: This includes conditions like tetany, which involves involuntary muscle contractions, spasms, and cramping. The hyperexcitable state of the nervous system during withdrawal can lead to symptoms akin to tetany.
3. Restless Legs Syndrome (RLS): RLS is a disorder that causes an uncontrollable urge to move one’s legs, usually due to an uncomfortable sensation. It typically happens in the evening or nighttime when you’re sitting or lying down. Withdrawal can induce similar feelings and an urge to move to relieve discomfort.
4. Myopathy: Myopathies are diseases that cause problems with the tone and contraction of skeletal muscles. Withdrawal might mimic myopathy through symptoms like muscle weakness and rapid fatigue.
5. Cramp-Fasciculation Syndrome: This syndrome is characterized by muscle cramps and fasciculations (twitching of small muscle fibers). Withdrawal from benzodiazepines can similarly lead to cramps and twitching as the neuromuscular junctions become more excitable.
6. Multiple Sclerosis (MS): Though benzo withdrawal does not cause MS, the muscular symptoms like spasticity, muscle spasms, and weakness can be similar to those experienced by MS patients.
7. Periodic Paralysis: This includes rare genetic disorders that lead to temporary episodes of muscle weakness or paralysis. While benzo withdrawal does not induce paralysis, the weakness experienced may feel akin to this condition.
8. Chronic Fatigue Syndrome (CFS): CFS is a complex disorder characterized by extreme fatigue that worsens with physical or mental activity but doesn’t improve with rest. Muscle pain and lethargy during withdrawal can be mistaken for CFS.

It is important to note that while the muscular symptoms during benzodiazepine withdrawal might resemble these conditions, they are a result of the neurochemical changes due to the cessation of benzodiazepine use rather than the conditions themselves. Furthermore, a study by Lader and Petursson in 1983 indicated that muscle symptoms can persist for months after benzodiazepines have been completely withdrawn as the GABA receptors upregulate. But take heart, they eventually go away.

Coping Strategies

Here are some non-pharmacological strategies that may help alleviate muscle-related withdrawal symptoms:

1. Gradual Tapering: A gradual reduction in dosage can minimize withdrawal symptoms.
2. Regular Exercise: Gentle exercises such as yoga, swimming, and walking can help maintain muscle tone and reduce tension. Exercise also enhances the release of endorphins, natural mood elevators, and painkillers.
3. Adequate Hydration: Staying well-hydrated is crucial as it helps in the optimal functioning of muscles and can relieve cramps and spasms.
4. Healthy Diet: Consuming a diet rich in magnesium and potassium can help muscle function and reduce cramping. Foods such as bananas, avocados, sweet potatoes, melons, leafy greens are excellent sources.
5. Heat Therapy: Applying a heat pack to tense or painful muscles can increase blood flow and relax the muscles.
6. Massage: Gentle massage can help reduce muscle tension, provide relaxation, and improve circulation. Deep tissue or sports massage can rev up symptoms. Gentle stroking is best.
7. Mindfulness and Relaxation Techniques: Meditation, deep-breathing exercises, or progressive muscle relaxation can decrease stress and muscle tension.
8. Supportive Environment: Creating a calming environment and having a supportive network can help reduce stress, which may indirectly help alleviate muscle symptoms.
9. Biofeedback: This technique involves becoming more aware of physiological functions (like muscle tension) and learning to control them, which can be especially helpful in managing withdrawal symptoms. (Biofeedback and neurofeedback has helped some, while others report it to be revving.)
10. Hydrotherapy: Some individuals find relief in water therapy, including soaking in warm baths or using water jets that massage the body.
11. Physical Therapy: You may find relief in working with a physical therapist.
12. Gentle Stretching: Stretching can offer some relief. Be gentle, and do not force your body to do more than it can.
13. Acupuncture: This ancient healing modality has helped some but revved up others. If you try it, let your acupuncturist know you must start slowly with treatment.

What to Avoid

• GABAergic medications and supplements should be avoided while recovering from benzodiazepine withdrawal.
• It may be tempting to take a muscle relaxant, but it is not recommended as they work on GABA.
• If you need over-the-counter pain relief from time to time, Tylenol is better tolerated than Advil for most people.
• Marijuana substances such as CBD and THC are somewhat controversial in the benzo community. Some feel they are helpful, while others have had horrific experiences with them.
• Baths with Epsom Salts usually rev up symptoms due to the magnesium and are not recommended.
• Deep tissue, sports, cranial sacral, or trigger point types of massage can rev up symptoms.

Conclusion

While benzo withdrawal can be challenging, especially when it comes to its effects on muscle health, several coping strategies can be employed. It is crucial to approach withdrawal with a holistic mindset, considering the physical and psychological aspects of well-being.

These strategies, along with personal resilience and possibly the guidance of a health and wellness coach, can support the journey toward recovery. It’s important to remember that while withdrawal is temporary, the benefits of becoming benzo-free will last a lifetime. You will thrive!

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How do you cope with muscle issues in benzo withdrawal?