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Magnesium as an Alternative or Adjunct to Opioids for Migraine and Chronic Pain: A Review of the Clinical Effectiveness and Guidelines

PainSci » bibliography » Banerjee et al 2017
updated
Tags: nutrition, self-treatment, treatment

Five pages on PainSci cite Banerjee 2017: 1. The Complete Guide to Trigger Points & Myofascial Pain 2. Does Epsom Salt Work? 3. 38 Surprising Causes of Pain 4. Vitamins, Minerals & Supplements for Pain & Healing 5. Magnesium supplementation as a pain killer 

PainSci commentary on Banerjee 2017: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This paper concluded in 2016 that “magnesium appears to have an analgesic effect.” Great! But don’t read the fine print if you want to hang on to that good feeling. Their own summary of findings doesn’t seem to back up the optimism. They clearly state that conclusions were “not possible” for migraine … that the evidence is conflicting for a rather exotic kind of chronic pain (complex regional pain syndrome) … and they mention only a single trial showing a benefit for back pain (with intravenous supplementation, no less, and for back pain complicated by neuropathy; see Yousef).

And that’s just all they wrote about the data. If there is enough evidence to justify “magnesium appears to have an analgesic effect,” it is not reported in this paper.

~ Paul Ingraham


Common issues and characteristics relevant to this paper: ?Scientific papers have many common characteristics, flaws, and limitations, and many of these are rarely or never acknowledged in the paper itself, or even by other reviewers. I have reviewed thousands of papers, and described many of these issues literally hundreds of times. Eventually I got sick of repeating myself, and so now I just refer to a list common characteristics, especially flaws. Not every single one of them applies perfectly to every paper, but if something is listed here, it is relevant in some way. Note that in the case of reviews, the issue may apply to the science being reviewed, and not the review itself.

  1. Exaggeration in the direction of a more interesting result (e.g. speculating about causality in data that only shows correlation).
  2. Garbage in, garbage out — not enough good quality data to meaningfully review/analyze.

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Migraine and chronic pain are common disorders and can result in considerable disability. According to the World Health Organization, migraine is ranked 19(th) with respect to health disorders causing life lived with disability. The lifetime prevalence of migraine in Canada has been estimated to be 24% in women and 9% in men. Chronic pain is defined as pain that persists for greater than three months. Chronic pain is associated with a variety of disorders such as chronic low back pain, chronic complex regional pain syndrome (CPRS), fibromyalgia and neuropathy. Estimates of the prevalence of chronic pain in Canada vary between 16% and 40%. The variability may be due to differences in the definitions used for chronic pain, sample populations surveyed, and the survey methodologies.

Treatment for migraine can be divided into two broad categories: acute treatment for migraine attacks and prophylactic treatment to reduce the frequency of migraine attacks. Treatment of any type of pain is complex and the best options for treatment still remain unresolved. Increasingly, opioids are being used for the alleviation of pain. However, long term use of opioids can lead to addiction, development of tolerance, and resistance of chronic pain to opioid analgesia. In addition, it is associated with side-effects such as chronic constipation, dizziness, consciousness disorders, and cognitive impairment. Hence other modalities for managing pain are needed. Magnesium plays an important physiological role and affects a number of processes. It is the fourth most abundant cation in the body, and is involved in regulation of protein synthesis, energy production, cell growth, and RNA and DNA synthesis. Magnesium modulates ion transport by pumps, carriers and channels and can impact signal transduction. Magnesium acts as a N-methyl-D-aspartate (NMDA) receptor antagonist and blocks the NMDA receptor, resulting in its analgesic effect. Activation of the NMDA receptor plays a role in central sensitization and is associated with spontaneous pain and increased reaction to peripheral stimuli. As magnesium appears to have an analgesic effect there is growing interest in investigating whether magnesium can be used as an alternative or as an adjunct to opioids for controlling pain.

The purpose of this report is to review the clinical effectiveness of magnesium as an analgesic for the treatment of adult patients with migraine or chronic pain. Additionally, this report aims to review evidence-based guidelines regarding the use of magnesium as an analgesic for the treatment of adult patients with migraine or chronic pain.

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