Abstract
BackgroundChronic pain is a highly prevalent and complex health problem that is associated with a severe symptom burden, as well as substantial economic and social impact. Many patients with chronic pain still suffer from unrelieved or undertreated pain due to the incomplete efficacy and dose-limiting adverse effects of current therapies. Long-term and high-dose opioid use has considerably increased in the past 20 years despite limited evidence supporting its effectiveness in several chronic pain conditions, and serious concerns have emerged regarding adverse effects and potential misuse. Until recently, the steady increase in opioid prescribing rates has been associated with rising opioid-related mortality and other serious problems, emphasizing the need for better nonopioid therapies. Emerging evidence supports the safe use of magnesium in controlling chronic pain, but its overall efficacy and safety is still unclear.ObjectiveThis paper aims to assess the efficacy and safety of magnesium compared with a placebo for the treatment of chronic noncancer pain.MethodsWe will conduct a detailed search on Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE from their inception until the date the searches are run to identify relevant randomized controlled trials. The reference lists of retrieved studies as well as Web-based trial registries will also be searched. We will include randomized double-blind trials comparing magnesium (at any dose, frequency, or route of administration) with placebo using participant-reported pain assessment. Two reviewers will independently evaluate studies for eligibility, extract data, and assess trial quality and potential bias. Risk of bias will be assessed using criteria outlined in the Cochrane Handbook for Systematic Review of Interventions. Primary outcomes for this review will include any validated measure of pain intensity or pain relief. Dichotomous data will be used to calculate the risk ratio and number needed to treat or harm. The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.ResultsThis protocol is grant-funded and has undergone a peer-review process through the Queen’s University Department of Anesthesiology and Perioperative Medicine Vandewater Endowed Studentship. This project is also supported, in part, by the Chronic Pain Network of the Canadian Institutes of Health Research Strategy for Patient-Oriented Research. The electronic database search strategies are currently being developed and modified. The entire review is expected to be completed by January 1, 2019.ConclusionsThe completion of this review is expected to identify available high-quality evidence describing the efficacy and safety of magnesium for the treatment of chronic noncancer pain.International Registered Report Identifier (IRRID)PRR1-10.2196/11654
Highlights
Description of the ConditionChronic pain is a significant health problem given its prevalence, impact on quality of life, economic burden, and difficult management
Chronic pain is associated with increased mortality and has major negative impacts on daily living activities and work-related outcomes, such as employment status, days missed from work, and productivity [4]
The direct health care and productivity costs of chronic pain are as high as US $635 billion per year in the United States and Can $43 billion per year in Canada, which exceed the annual costs from cancer and heart disease [11,12]
Summary
Description of the ConditionChronic pain is a significant health problem given its prevalence, impact on quality of life, economic burden, and difficult management. The direct health care and productivity costs of chronic pain are as high as US $635 billion per year in the United States and Can $43 billion per year in Canada, which exceed the annual costs from cancer and heart disease [11,12]. Pharmacological agents such as antidepressants, anticonvulsants, opioids, nonsteroidal inflammatory drugs, and muscle relaxants are frequently used for pain management [13,14]. Emerging evidence supports the safe use of magnesium in controlling chronic pain, but its overall efficacy and safety is still unclear
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