magnesium
Place in Therapy
Place in Therapy
A review of the current data suggests that there is limited evidence that magnesium may reduce pain compared with placebo in women 16-42 with moderate-severe primary dysmenorrhea. The primary literature includes three small trials; one randomized controlled trial and two descriptive studies, all completed from 1989-1992. One study was completed in Germany, another in Switzerland and another in the United States of America. The trials were small (under 50 patients) and had varying designs, using different formulations and doses of magnesium. Measuring and reporting of pain outcomes was largely subjective. Studies additionally had a significant withdrawal rate (due to lack of effect in both treatment and placebo groups).
Two trials showed that magnesium was more effective than placebo in reducing pain (1,2), while another descriptive trial showed that magnesium was no different than placebo (3). Treatment was administered differently in each study (continuous once daily dosing or during menses only) and it is unclear which dose or treatment regimen is more effective (1-3).
One Cochrane systematic review determined that magnesium may be a promising treatment for dysmenorrhea, however it is unclear what dose or regimen of treatment should be recommended, due to the variations in the included trials, therefore no strong recommendation can be made (4). Additionally clinical guidelines, like Dynamed, have indicated that magnesium may reduce pain in dysmenorrhea as “level-2 evidence”, indicating that the research is not of high enough quality to make a confident recommendation (5). Uptodate has similarly concluded that while magnesium is well tolerated, due to the poor quality of studies and varying designs, no definite recommendation for the use of magnesium or optimum dose can be made (6).
It is difficult to generalize the available data to the public as two of the three studies were completed in Europe. Different formulations, treatment lengths and methods were used in each study, so it likewise difficult to suggest a particular formulation or dosing regimen. Studies did not describe treatment allocation and concealment and did not provide details on randomization. Overall, larger and well-designed randomized-controlled trials need to be conducted before a definitive recommendation of using magnesium for the treatment of primary dysmenorrhea can be made.
However, magnesium was well tolerated in each study with minimal adverse events (localized to gastrointestinal side effects), and overall showed an improvement in pain compared to placebo. Based on the studies that have been conducted, it is concluded that its use within the algorithm is limited and should be considered if NSAIDs are contraindicated, ineffective or if the patient wishes to try a natural health product.
References:
1. Seifert B, Wagler P, Dartsch S, Schmidt U, Nieder J. Magnesium-a new therapeutic alternative in primary dysmenorrhea. Zentralblatt fur Gynakologie 1989;111(11): 755–60.
2. Fontana-Klaiber H, Hogg B. Therapeutic effects of magnesium in dysmenorrhea. Schweizerische Rundschau fur Medizin Praxis 1990;79(16):491–4
3. Davis LS. Stress, vitamin B6 and magnesium in women with and without dysmenorrhea: a comparison and intervention study [dissertation]. Austin TX: University of Texas. December 1988.
4. Wilson ML, Murphy PA. Herbal and dietary therapies for primary and secondary dysmenorrhea. Cochrane Database of Systematic Reviews. 2001;(3) CD002124.
5. DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 – 2013. Dysmenorrhea Treatment; [updated 2013 June 03;] Accessed July 16, 2013. Available from http://search.ebscohost.com/login.aspx?direct=true&site=DynaMed&id=113862.
6. Smith RP, Kaunitz AM. Treatment of primary dysmenorrhea in adult women. Uptodate. Accessed July 16, 2013.
A review of the current data suggests that there is limited evidence that magnesium may reduce pain compared with placebo in women 16-42 with moderate-severe primary dysmenorrhea. The primary literature includes three small trials; one randomized controlled trial and two descriptive studies, all completed from 1989-1992. One study was completed in Germany, another in Switzerland and another in the United States of America. The trials were small (under 50 patients) and had varying designs, using different formulations and doses of magnesium. Measuring and reporting of pain outcomes was largely subjective. Studies additionally had a significant withdrawal rate (due to lack of effect in both treatment and placebo groups).
Two trials showed that magnesium was more effective than placebo in reducing pain (1,2), while another descriptive trial showed that magnesium was no different than placebo (3). Treatment was administered differently in each study (continuous once daily dosing or during menses only) and it is unclear which dose or treatment regimen is more effective (1-3).
One Cochrane systematic review determined that magnesium may be a promising treatment for dysmenorrhea, however it is unclear what dose or regimen of treatment should be recommended, due to the variations in the included trials, therefore no strong recommendation can be made (4). Additionally clinical guidelines, like Dynamed, have indicated that magnesium may reduce pain in dysmenorrhea as “level-2 evidence”, indicating that the research is not of high enough quality to make a confident recommendation (5). Uptodate has similarly concluded that while magnesium is well tolerated, due to the poor quality of studies and varying designs, no definite recommendation for the use of magnesium or optimum dose can be made (6).
It is difficult to generalize the available data to the public as two of the three studies were completed in Europe. Different formulations, treatment lengths and methods were used in each study, so it likewise difficult to suggest a particular formulation or dosing regimen. Studies did not describe treatment allocation and concealment and did not provide details on randomization. Overall, larger and well-designed randomized-controlled trials need to be conducted before a definitive recommendation of using magnesium for the treatment of primary dysmenorrhea can be made.
However, magnesium was well tolerated in each study with minimal adverse events (localized to gastrointestinal side effects), and overall showed an improvement in pain compared to placebo. Based on the studies that have been conducted, it is concluded that its use within the algorithm is limited and should be considered if NSAIDs are contraindicated, ineffective or if the patient wishes to try a natural health product.
References:
1. Seifert B, Wagler P, Dartsch S, Schmidt U, Nieder J. Magnesium-a new therapeutic alternative in primary dysmenorrhea. Zentralblatt fur Gynakologie 1989;111(11): 755–60.
2. Fontana-Klaiber H, Hogg B. Therapeutic effects of magnesium in dysmenorrhea. Schweizerische Rundschau fur Medizin Praxis 1990;79(16):491–4
3. Davis LS. Stress, vitamin B6 and magnesium in women with and without dysmenorrhea: a comparison and intervention study [dissertation]. Austin TX: University of Texas. December 1988.
4. Wilson ML, Murphy PA. Herbal and dietary therapies for primary and secondary dysmenorrhea. Cochrane Database of Systematic Reviews. 2001;(3) CD002124.
5. DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 – 2013. Dysmenorrhea Treatment; [updated 2013 June 03;] Accessed July 16, 2013. Available from http://search.ebscohost.com/login.aspx?direct=true&site=DynaMed&id=113862.
6. Smith RP, Kaunitz AM. Treatment of primary dysmenorrhea in adult women. Uptodate. Accessed July 16, 2013.