The physical symptoms and how to help sufferers to deal with them are:
Balance, Co-Ordination And Concentration
Pain And Sensation
Sleeping And Tiredness
Balance, Co-Ordination And Concentration
As with many physical symptoms these are unpleasant enough individually, but much worse when they occur in combination, which they do. They are often some of the last symptoms to go.
Balance. There are two components in balance – the eyes and inner ears, which tell the brain about the body’s present activity, and the posture which keeps the body upright, adjusting for changes of terrain and so on. The result of either of these getting out of sync is poor balance and/or dizziness, feeling unsteady on the feet, the room ‘spinning’ even when sitting or lying, feeling drunk, and both of these components occur during withdrawal. This leads to the risk of falling, particularly in older people, colliding with objects, inadvertently burning oneself, tripping, and general clumsiness. The dizziness can also lead to nausea.
Coordination. Allied to balance is coordination or rather lack of it. If anything this is even more frustrating, because for people who are normally adept, being unable to do such simple things as do up a zip or turn a key in a lock is infuriating. This affects many normal daily activities such as dressing, cooking, using a computer, driving or even walking. More complex activities, artistic, sporting, or social can all be affected. Eating out for instance is embarrassing if the food ends up on the floor.
Concentration. Activities such as reading become difficult since the illness deprives people of the ability to concentrate. This has many far-reaching implications, such as the effect on conversation. Chats become difficult to follow; topics are missed or inadvertently ignored and social embarrassment results. The effort of concentrating is tiring and the longer the conversation the worse it gets. The patient is unable to focus their attention, acquire new information, decipher directions or follow simple instructions.
Helping. All of the problems described obviously place strong limitations on a sufferer’s life. The carer needs to provide support literally by helping the sufferer to avoid accidents, not attempting any risky physical activity and using aids such as walking sticks. They also need to be emotionally supportive because the sufferer is likely to resent very strongly the fact that many of the things they did pre-benzodiazepine they cannot now do, and this is very frustrating. This is certainly true for my wife. Since time is the only certain cure, much of the withdrawal and recovery is essentially passing time. So the carer must try to devise ways to occupy the sufferer within the limits of the latter’s ability. Sometimes there is not much the carer can do except encourage whenever possible and refrain from taking over. As always balance is all-important. Planned exercises can also help.
Pain And Sensation
Pain. During withdrawal, dull aches and pains can be experienced in almost any part of the body including the muscles, lower, middle or upper back, face, arms and feet, head, forehead, soft tissue, teeth and mouth. Examples are the feeling of an imaginary band around the head constantly being tightened, muscles aching as if tired after exertion, a dry sore mouth, and facial numbness.
Sensations. Apart from direct pain people experience varieties of physical sensation which do not make much apparent sense. For instance, people report feeling insects crawling on their skin, when obviously there are not. Sensations such as burning skin, the feeling of electrical shocks, unexpected thirst, pins and needles, sweating, apparent temperature changes, hypersensitivity to touch are all reported. Sensations can appear on any part of the body, often the shoulders, back, hands and feet. Sometimes people are just hypersensitive to touch. One particularly strange sensation is the feeling of the brain moving inside the head. Not surprisingly tests done on sufferers tend to reveal nothing amiss.
Helping. Treating benzodiazepine-induced pain is difficult because the normal pain response mechanisms are not involved directly in the usual way. If, for example, you hit your thumb with a hammer, your thumb hurts because your brain says it hurts. Sensory neurons in your thumb send a message to your brain via the spinal cord, and the brain decides damage may have been done to your thumb. It also decides you need to do something, so you swear and feel better. But if like my wife you experience the common burning sensation which feels as if your skin is sunburnt, when quite clearly it isn’t, this does not seem to be part of the normal pain mechanism. As before your brain is telling you that you are sunburnt, but the message doesn’t seem to be coming from the nerves in your skin. Treating the skin with, say, Aloe Vera, which would normally relieve sunburn, may help or it may not. It seems to depend on your psychological state at the time. My wife has tried various things such as E45 moisturizer and Oilatum which you add to bathwater, but whereas both are pleasant in their own way, neither has any long-term effect.
Vision. A common problem is blurred or double vision, which results in difficulty with reading, watching television, or just focusing on something going on around you. Eyes can be sore, dry, red, tired, or have a glassy appearance not unlike those of a street drug addict. They can be more than usually sensitive to light intensity in that everything seems unbearably bright, even leading to the need to wear sun glasses indoors. Sufferers are unable to look at computer screens. Worse is visual distortion where people start seeing things, flashing lights, inanimate objects appearing to move, people appearing flat, one-dimensional and paper-like, buildings leaning, floors undulating. Rapid changes of stimulus as occur during television advertising for example can cause sensory overload when the brain just can’t cope. My wife just used to go to sleep sometimes. Crowds can produce a similar effect.
Hearing. The hypersensitivity which applies to sight can also apply to hearing. Everyday sounds such as those produced by cutlery, crockery, people, and normal surroundings seem abnormally loud. Tinnitus also occurs in the form of a constant or intermittent ringing in the ears.
Speech. The principal problem with speech is that there seems to be a disconnection between the brain and the mouth. By the time sentences which appear perfectly lucid in the mind come out through the mouth, they have become distorted, with phrases scrambled or incomplete, and words missing. This is often aggravated by memory failures. The effort of concentrating on just saying something which makes sense is exhausting and makes a normally fluent conversation very difficult.
Helping. There is probably little that the carer can do to help except re-assure the sufferer that normal sensitivity will return. The solutions we have adopted are to avoid visual stimuli by simply looking elsewhere, or closing your eyes. Sounds can be muffled. The speech problem seems to come in waves of lucidity followed by confusion, almost certainly related to the inability to concentrate. The carer should listen without taking over, but prompt gently. This seems to help the conversation to run as smoothly as possible.
Heart. The most commonly reported symptom is palpitation, as well as irregular or rapid beating. The heart is said to be feeling as if it is jumping out of the chest cavity. These are usually associated with panic attacks and can be treated in the same way.
Lungs. Similar irregularity is reported for the lungs, namely breathing faster and deeper than necessary and hyperventilating. Also reported are sore throats and a choking sensation.
Digestive System. Sufferers report a wide range of digestive symptoms. The mouth feels dry and lacking in saliva, and there is a strong urge to keep drinking. Taste is distorted and can be metallic, and the nerves in the teeth and gums can hurt. Oesophageal spasms occur giving the feeling of a choking throat. The stomach is particularly sensitive to generalised pain and specific symptoms such as vomiting, reflux, nausea, and cramps. People’s appetite changes leading to unexplained fluctuations in weight. Cramps also occur in the abdomen, but the most commonly reported abdominal symptom is distension or bloating, described as “benzo belly”, when the sufferer has a potbelly or even looks pregnant. Both diarrhoea and constipation occur.
Limbs. On a par with benzo belly is “jelly legs” where the legs feel weak and rubbery as if about to give way. Problems with limbs vary from restlessness through to feeling like lead. People complain of uncontrollable tremors and twitching and other involuntary movements. They feel the need to move around and the overwhelming urge to move their legs when lying down. The opposite also occurs, where people’s limbs feel very heavy, and their muscles feel as if they have just done rigorous exercise. Their joints and muscles hurt.
Water Retention. People complain of fluid retention (oedema) taking the form of swollen feet, hands or eyelids, or generally looking puffy. This can occur with urinary problems, such as needing to urinate more frequently than usual, partial or complete incontinence, pain when urinating and bladder hypersensitivity.
Body temperature. Apparent fluctuations in body temperature occur, even though the thermometer disagrees. This is accompanied by fever-like symptoms, such asprofuse sweating, sometimes alternating with feeling cold, and pain in the joints or muscles.
Hormones. The normal hormonal processes seem to be upset causing menstrual irregularity and cramps, premenstrual tension, unexpected hot flashes. People also report a loss of interest in sexual intercourse and an inability to become aroused.
Fits. Fits (like epileptic attacks) though rare can occur but are usually related to withdrawing cold turkey.
Hair and Nails. Just to add to the list of unpleasant physical symptoms hair loss or breakage and a change in texture are reported. Nails can become discoloured, looking jaundiced or grey, and can become weak and split.
Skin. Intense burning feeling. Rashes.
Head. Feeling of a band round the forehead
Helping. Many people report going to their GP for tests for particular body symptoms, which is a wise move if in fact there is a separate problem going on. However both carer and sufferer must be aware that the GP may mistakenly diagnose an ailment which is actually a symptom of withdrawal, confirmed by the fact that tests often prove negative. More complicated are infections. People withdrawing are subject to stress, and their immune system is quite possibly working below par. At this point a visit to the doctor is called for.
Clearly many of the symptoms above may respond to conventional treatment, a laxative for constipation for instance. Others will probably have to wait until recovery is underway.
Sleeping and Tiredness
One of the most important correct uses of benzodiazepines is to deal with ACUTE insomnia. However sleep disturbances are a commonly reported feature of withdrawal accompanied by dreams, nightmares, and teeth grinding. Disturbances take the form of successive nights without sleep, too few hours of sleep per night, and waking up throughout the night, and then being unable to go back to sleep. Coupled with this is a general feeling of tiredness and weakness. People lack energy and any incentive to do things, are listless and lethargic. Waking up with a bang accompanied by panic feelings happens. Unpleasant dreams will recede as the brain repairs.
On the other hand some people find that they need very much more sleep at night and during the day, and report staying in bed for days at a time. Doing too much on one day can produce the need for more rest than usual on the following one.
Helping. Benzodiazepines inhibit dreams, so withdrawing encourages dreams and sometimes nightmares, so try to avoid any stimulants such as caffeinated coffee or alcohol, which could make things worse, before bedtime. Some people respond to soothing sounds or music, discs of which are readily available. The body has a strong attachment to ensuring sleep, so recovery will see sleep return to normal and nightmares recede.