Magnesium in pain therapy – historical notes and current aspects

Büntzel J1, Kisters K2, Büntzel S K3, Micke O4 

1Klinik für Hals-Nasen-Ohren-Heilkunde, Südharz Klinikum Nordhausen, Nordhausen, DE

2Medizinische Klinik I, St. Anna Hospital Herne, Herne, DE

3Klinikum der Otto-von-Guericke-Universität Magdeburg, DE

4Klinik für Strahlentherapie und Radioonkologie, Franziskus Hospital, Bielefeld, DE

 

Since 1906 Meltzer an his colleagues have reported the use of magnesium sulphate in the context of anesthesia (1). After 1945 the topic got new attenton with the publications of Rawlings (2) (dysmenorrhea) and Dunakhe (3) (trigeminus neualgia). Today (31-10-2022) we find at Pubmed 1801 hits for the Mesh Terms „pain“ and „magnesium“.

A shortly published systematic review (4) included 81 randomized controlled studies with 5447 patients, investigating the effects of magnesium as co-analgetic in the field of pain therapy. Main focus seems tob e on postoperative pain (n=50 studies), migraine patients (n=18), renal pain (n=5), neuropathic/chronic pain (n=6) and fibromyalgia (n=2). Studies with positive results of intravenous administartion (>7,5 mg/kg) were reported for postoperative pain (15/50), migraine (4/9), renal pain (2/5) and neuropathic/chronic pain (2/4). Oral administration (> 50 mg magnesium oxidde daily) were succesful given in 2/2 studies investigating fibromaylgia, 5/8 studies with migraine patients, and 0/1 study on neuropathic/chronic pain. The duration of oral intake was in median 12 weeks. The authors recommend cancer pain therapy and the rheumatoid pain therapy as potential fields of further research.

Own research focus on magnesium as con-analgesic for post-operative pain in tonsillectomy patients. We have seen a higher pain sensitivity in such patients who shows decreased serum-magnesium levels (5). Rondomized studies have showns effects of supplementation for such tonsillectomy patients (6, 7). Furthermore, the perioperative administration of magnesum could help to decrease the whole post-tosillectomy complication profile (8). There is also a EBM-based recommendation to use magnesium as adjunct to local anesthesia in ordert o prevent laryngeal spasm during and after tonsillectomy (9).

  1. Auer J, Meltzer SJ. THE INTRAVENOUS INJECTION OF MAGNESIUM SULPHATE FOR ANESTHESIA IN ANIMALS. J Exp Med. 1916 May 1;23(5):641-53. doi: 10.1084/jem.23.5.641. PMID: 19868013; PMCID: PMC2125448.
  2. RAWLINGS WJ. Magnesium in dysmenorrhoea. Med J Aust. 1949 Jan 15;1(3):61-4. PMID: 18110970.
  3. DUNAKHE KS. A case note on trigeminal neuralgia treated with magnesium sulphate. Antiseptic. 1949 Feb;46(2):129. PMID: 18125606.
  4. Morel V, Pickering ME, Goubayon J, Djobo M, Macian N, Pickering G. Magnesium for Pain Treatment in 2021? State of the Art. Nutrients. 2021 Apr 21;13(5):1397. doi: 10.3390/nu13051397. PMID: 33919346; PMCID: PMC8143286.
  5. Büntzel J, Kisters K, Micke O, Mücke R, Büntzel Ju: Serum magnesium level and post-operative pain sensation in patients after tonsillectomy, Trace Elements Electrol 2016; 33: 79-82. DOI 10.5414/TEX01426
  6. Tugrul S, Degirmenci N, Eren SB, Dogan R, Veyseller B, Ozturan O. Analgesic effect of magnesium in post-tonsillectomy patients: a prospective randomised clinical trial. Eur Arch Otorhinolaryngol. 2015 Sep;272(9):2483-7. doi: 10.1007/s00405-014-3219-8. Epub 2014 Aug 6. PMID: 25097030.
  7. Hamed MA, Al-Saeed MA. The Efficacy of Intravenous Magnesium Sulfate versus Intravenous Paracetamol on Children Posttonsillectomy Pain and Analgesic Requirement: A Randomized Controlled Study. Anesth Essays Res. 2018 Jul-Sep;12(3):724-728. doi: 10.4103/aer.AER_113_18. PMID: 30283184; PMCID: PMC6157232.
  8. Cho HK, Park IJ, Yoon HY, Hwang SH. Efficacy of Adjuvant Magnesium for Posttonsillectomy Morbidity in Children: A Meta-analysis. Otolaryngol Head Neck Surg. 2018 Jan;158(1):27-35. doi: 10.1177/0194599817730354. Epub 2017 Sep 12. PMID: 28895485.
  9. Vlok R, Melhuish TM, Chong C, Ryan T, White LD. Adjuncts to local anaesthetics in tonsillectomy: a systematic review and meta-analysis. J Anesth. 2017 Aug;31(4):608-616. doi: 10.1007/s00540-017-2310-x. Epub 2017 Jan 24. PMID: 28120104.