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Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant
Background and Aims The use of Magnesium Sulfate (MS) has shown favorable effects in the modulation of postoperative pain, however its efficacy in the context of neuropathic pain has not been conclusively established. Our objective was to evaluate the available evidence to determine the therapeutic potential of its use in the management of neuropathic pain.
Methods Randomized controlled trials (RCT) comparing the use of MS (intravenous or oral route) with placebo or other neuromodulators in adult patients with neuropathic pain were included. Comprehensive searches were conducted in PubMed, EMBASE, Google Scholar, and BVS-LILACS databases from 1990 to May 2023. The risk of bias in the individual studies was assessed using the Cochrane ”Risk of Bias 2.0” tool. The results were synthesized using the Mantel-Haenszel random-effects method to calculate mean differences and their 95% confidence intervals. Heterogeneity was evaluated using the I2 statistic. Registration: PROSPERO CRD42023441885.
Results 7 RCTs with 274 patients were included. The pooled analysis of the studies comparing magnesium sulfate to placebo showed a non-significant mean difference of -1.13 (95% CI: -2.64, 0.38) in neuropathic pain scores, despite a favorable trend towards magnesium sulfate observed in the sequential trial analysis, but with high heterogeneity (I2 = 81%). The comparison between magnesium sulfate and ketamine revealed a decrease in the mean difference of -0.67 (95% CI: -1.84, 0.49), without reaching statistical significance, moderate heterogeneity (I2 = 62%).
Sulfate_Placebo
Sulfate vs Ketamine
Conclusions Magnesium sulfate could be an effective therapeutic alternative for neuropathic pain, but further primary studies are required to establish the optimal dosing regimens and clinical contexts