An explanatory study evaluating the muscle relaxant effects of intramuscular magnesium sulphate for dystonia in complex regional pain syndrome

J Pain. 2013 Nov;14(11):1341-8. doi: 10.1016/j.jpain.2013.05.013. Epub 2013 Aug 15.

Abstract

The treatment of dystonia related to complex regional pain syndrome (CRPS) remains unsatisfactory, raising the need of alternative targets for intervention. In dystonia, pathologic muscle changes may occur, which contributes to stiffness. Because magnesium sulphate may act as a muscle relaxant through its actions on the neuromuscular junction and muscle, we performed an explanatory study of the muscle relaxant effect and safety of intramuscular magnesium sulphate (IMMG) in CRPS patients with dystonia. In a double-blind randomized placebo-controlled crossover study, 30 patients were assigned to 3-week treatments of IMMG and placebo. Treatments were separated by a 1-week washout period. The daily dose of IMMG was 1,000 mg in week 1, 1,500 mg in week 2, and 2,000 mg in week 3. The primary outcome measure was the difference in change in Burke-Fahn-Marsden scores after 3 weeks of treatment between both interventions. Secondary outcomes involved severity of dystonia, myoclonus, tremor, and pain, and functional activity. Data of 22 patients available for the explanatory analysis revealed no significant differences between IMMG and placebo treatment in any of the outcomes. In conclusion, we found no indication of efficacy of IMMG in a daily dose of 2,000 mg as a muscle relaxant in CRPS-related dystonia.

Perspective: In this double-blind placebo-controlled crossover study there was no evidence found of a muscle relaxant effect of intramuscular magnesium sulphate in dystonia related to CRPS. Consequently, there is insufficient support for new studies evaluating the efficacy of other routes of MG administration in CRPS-related dystonia.

Keywords: Intramuscular; complex regional pain syndrome; dystonia; magnesium sulphate.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Complex Regional Pain Syndromes / complications*
  • Cross-Over Studies
  • Double-Blind Method
  • Dystonia / complications
  • Dystonia / drug therapy*
  • Female
  • Humans
  • Injections, Intramuscular
  • Magnesium Sulfate / adverse effects
  • Magnesium Sulfate / pharmacology
  • Magnesium Sulfate / therapeutic use*
  • Male
  • Middle Aged
  • Neuromuscular Agents / adverse effects
  • Neuromuscular Agents / pharmacology
  • Neuromuscular Agents / therapeutic use*
  • Pain Measurement
  • Treatment Outcome

Substances

  • Neuromuscular Agents
  • Magnesium Sulfate