Magnesium for Pain Treatment in 2021? State of the Art

Abstract

Background: Magnesium (Mg) is commonly used in clinical practice for acute and chronic pain and has been reported to reduce pain intensity and analgesics consumption in a number of studies. Results are, however, contested. Objectives: This review aims to investigate randomised clinical trials (RCTs) on the effectiveness of Mg treatment on pain and analgesics consumption in situations including post-operative pain, migraine, renal pain, chronic pain, neuropathic pain and fibromyalgia. Results: The literature search identified 81 RCTs (n = 5447 patients) on Mg treatment in pain (50 RCTs in post-operative pain, 18 RCTs in migraine, 5 RCTs in renal pain, 6 RCTs in chronic/neuropathic pain, 2 RCTs in fibromyalgia). Conclusion: The level of evidence for the efficacy of Mg in reducing pain and analgesics consumption is globally modest and studies are not very numerous in chronic pain. A number of gaps have been identified in the literature that need to be addressed especially in methodology, rheumatic disease, and cancer. Additional clinical trials are needed to achieve a sufficient level of evidence and to better optimize the use of Mg for pain and pain comorbidities in order to improve the quality of life of patients who are in pain.

Nutritional Supplements for the Treatment of Neuropathic Pain

“…Magnesium is a trace metal readily available as an over-the-counter supplement proposed for the treatment of neuropathic pain. It is used in a number of neuropathic pain conditions, including diabetic neuropathy, cancer-related neuropathic pain, chemotherapyrelated neuropathy, and postherpetic neuralgia [54,55].…”

Cross-Talks between the Cardiovascular Disease-Sarcopenia-Osteoporosis Triad and Magnesium in Humans

“…Different populations, pathologies, missing information on severity of the patients's disease, different oral Mg chemical forms, or different settings are reported. A recent review [151] observed that eight chemical Mg forms have been studied head-to-head for bioavailability, and concluded that second-generation organic salts (citrate, pidolate, gluconate) are more bioavailable than first-generation inorganic salts (carbonate, chlorure, and oxide). It also stresses that third generation organic salts (bisglycinate, glycerophosphate) are more bioavailable than the other two generations.…”

“…Patients may also have orthopedic surgery after a fracture and experience post-surgical pain, another risk factor for the development of chronic and neuropathic pain [153], with peripheral and central mechanisms of pain at play. The use of Mg in pain relies on the fact that Mg is the physiological blocker of the N-Methyl-D-aspartate (NMDA) receptor, and controls its hyperexcitability in pain chronicization and in learning, cognitive, and emotional processes [151]. The molecular cascades described in pain are also thought to impact sleep, anxiety, and fatigue [151,154].…”

“…The use of Mg in pain relies on the fact that Mg is the physiological blocker of the N-Methyl-D-aspartate (NMDA) receptor, and controls its hyperexcitability in pain chronicization and in learning, cognitive, and emotional processes [151]. The molecular cascades described in pain are also thought to impact sleep, anxiety, and fatigue [151,154]. A recent review [151] reported a modest effect of Mg in chronic pain but also stressed that there is to date in the literature no RCT evaluating the benefits of Mg supplementation on pain occurring in osteoporosis, rheumatic disease, or sarcopenia.…”

“…The molecular cascades described in pain are also thought to impact sleep, anxiety, and fatigue [151,154]. A recent review [151] reported a modest effect of Mg in chronic pain but also stressed that there is to date in the literature no RCT evaluating the benefits of Mg supplementation on pain occurring in osteoporosis, rheumatic disease, or sarcopenia. Finally, Mg has been suggested as a supportive treatment of COVID-19, especially in critically ill patients [155].…”