Intravenous magnesium for neuropathic back pain.
Eighty patients (mean age, 56 years) with chronic low back pain with a neuropathic component, who had had an inadequate response to anticonvulsants, antidepressants, analgesics, and interferential current therapy, were studied. While continuing those treatments, they were randomly assigned to receive, in double-blind fashion, magnesium or placebo. Magnesium therapy consisted of 1 g of magnesium sulfate intravenously in 250 ml of 0.9% saline given over 4 hours every day for 2 weeks, followed by oral magnesium (245 mg twice) a day for 4 weeks. The placebo group received 0.9% saline intravenously followed by oral placebo. All patients reported a significant improvement in pain after 2 weeks, with no significant difference between groups. At 6 months, compared with baseline, a significant reduction in pain intensity was seen in the magnesium group (4.7 vs. 7.5 on a 10-point scale; p = 0.034). In contrast, mean pain intensity improved nonsignificantly in the placebo group, from 7.4 at baseline to 7.2 (p < 0.03 for the difference in the change between groups). The improvement in pain was also significantly greater in the magnesium group than in the placebo group at 6 weeks and 3 months. The reduction in pain intensity in the magnesium group was accompanied by significant improvement in lumbar spine range of motion during the follow-up period.
Comment: Persistent mechanical irritation of the nerve root (as seen with degenerated or herniated discs) sets up a series of events that lead to chronic pain, mediated by sensitization of the dorsal roots and dorsal horns in the spinal cord. Magnesium blocks sensitization in the central nervous system through its effect on N-methyl-D-aspartate receptors. The present study demonstrated that treatment with intravenous magnesium followed by oral magnesium over a 6-week period improved pain intensity and lumbar spine mobility during a 6-month period in patients with refractory chronic low back pain with a neuropathic component.
Yousef AA, Al-deeb AE. A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component. Anaesthesia. 2013;68:260-266.
by Alan R. Gaby, MD
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|Title Annotation:||Literature Review & Commentary|
|Author:||Gaby, Alan R.|
|Date:||Jan 1, 2014|
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