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To the Editor.—
Dr. Blackwell's article (225:1637, 1973) extolling the virtues of diazepam was particularly interesting to me because my specialty is rheumatology. I see a large sub-population of the emotionally disturbed patients whose main complaint is pain. My experience with diazepam as compared to the combination tranquilizer-antidepressants (eg, Triavil, Etrafon) has been just the opposite of Dr. Blackwell's.In the patients with pain, whether genuine inflammatory disease coexists or not, depression is common. Diazepam seems not only to have little value in the treatment of pain but also seems to unmask or aggravate depression. The antidepressants, on the other hand, do not show infrequently a marked decrease in pain in the individual whose primary problem seems to be anxiety-depression without inflammatory changes. In rheumatoid arthritis neither of these drugs has a significant effect on the pain.There has been no noticeable difference in side effects in my patients. Many
Dyer HR. Psychotropic Drugs in Rheumatology. JAMA. 1973;226(13):1572. doi:10.1001/jama.1973.03230130060038