Open AccessIntravenous Magnesium for Chronic Complex Regional Pain Syndrome Type 1 ( CRPS ‐1)
Author(s) -
Fischer Sigrid G. L.,
Collins Susan,
Boogaard Sabine,
Loer Stephan A.,
Zuurmond Wouter W. A.,
Perez Roberto S. G. M.
Publication year - 2013
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/pme.12211
Subject(s) - medicine , interquartile range , placebo , mcgill pain questionnaire , complex regional pain syndrome , physical therapy , anesthesia , randomized controlled trial , quality of life (healthcare) , visual analogue scale , alternative medicine , nursing , pathology
Objective To assess the effects of intravenous administration of magnesium on complex regional pain syndrome type 1 ( CRPS ‐1), a randomized double‐blind placebo‐controlled trial was performed. Methods Fifty‐six patients with CRPS ‐1 ( I nternational A ssociation for the S tudy of P ain O rlando criteria) received MgSO 4 70 mg/kg or placebo ( NaCl 0.9%) in 4 hours over 5 consecutive days. Pain ( BOX ‐11 and M c G ill), the level of impairment (Impairment level Sum Score [ ISS ]), functional limitations (Radboud Skills Questionnaire, Walking Skills Questionnaire/questionnaire rising and sitting down), participation (Impact on Participation and Autonomy [ IPA ]), and quality of life (Short Form‐36, E uro Q ol, IPA ) were evaluated at baseline and at 1, 3, 6, and 12 weeks. Results No significant differences were found between MgSO 4 and placebo on the BOX ‐11 and ISS at different time points during the trial on intention‐to‐treat and per‐protocol analysis. A significant improvement on the BOX ‐11 was found after the first week of the trial in both groups (mean 0.7; standard deviation 1.1). For the MgSO 4 group, a clinically relevant and statistically significant improvement on the ISS at 1 week (median 5, interquartile range [ IQR ] –1 to 8) and a significant improvement on the M c G ill up to 6 weeks (median 2 words, IQR 0–4.5) were found compared with baseline, which were not found in the placebo group. Significant improvement in perceived job participation was found for the MgSO 4 group at 12 weeks (median improvement 1.44–1.17; P = 0.01). ISS improved significantly more in patients with a low Hospital Anxiety and Depression Scale ( HADS ) score (≤10) in the MgSO 4 group (mean 4.4 vs mean −3.1; P = 0.02). Conclusion Administration of the physiological competitive N‐methyl‐D‐aspartate receptor antagonist magnesium in chronic CRPS provides insufficient benefit over placebo. Future research should focus on patients with acute CRPS and early signs and symptoms of central sensitization.