Phenobarbital versus clonazepam for sedative-hypnotic taper in chronic pain patients. A pilot study

Ann Clin Psychiatry. 1993 Jun;5(2):123-8. doi: 10.3109/10401239309148974.


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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Anxiety Disorders / chemically induced
  • Anxiety Disorders / diagnosis
  • Chronic Disease
  • Clonazepam / therapeutic use*
  • Double-Blind Method
  • Female
  • Hospitalization
  • Humans
  • Hypnotics and Sedatives / adverse effects*
  • MMPI
  • Male
  • Middle Aged
  • Pain / diagnosis
  • Pain / drug therapy*
  • Phenobarbital / therapeutic use*
  • Pilot Projects
  • Psychiatric Status Rating Scales
  • Substance Withdrawal Syndrome / diagnosis
  • Substance Withdrawal Syndrome / prevention & control*
  • Substance-Related Disorders / diagnosis
  • Substance-Related Disorders / drug therapy*


  • Hypnotics and Sedatives
  • Clonazepam
  • Phenobarbital