title: Intrathecal midazolam as supplementary analgesia for chronic lumbar pain--15 years' experience.
abstract: BACKGROUND
  The antinociceptive effect of intrathecal midazolam is based on its affecting spinal gamma-amino butyric acid receptors.
  
  
  OBJECTIVE
  To evaluate pain relief in patients with chronic low back pain and failed back surgery syndrome after a single-shot intrathecal administration of midazolam.
  
  
  METHODS
  A prospective, open-label study.
  
  
  METHODS
  The analgesic effect was determined using a patient questionnaire during subsequent visits to the pain therapy service. We classified at least a 50% pain reduction with improved quality of life and improved functional condition as a positive outcome.
  
  
  RESULTS
  Between 1995 and 2010, we performed 500 administrations: 227 administrations in 57 male patients and 273 administrations in 69 female patients. We performed 81 administrations for chronic low back pain and 419 administrations for failed back surgery syndrome. The average age of our patients was 50 years (range 28 to 86). The dose administered ranged from 2 to 5 mg of midazolam. The analgesic effect lasted 9.7 weeks on average, ranging from 1 week to 3 years; the most common reported duration was between 4 and 12 weeks (3 months). In 65% of patients, we achieved pain relief lasting 4 weeks or longer; in 13%, the administration provided no analgesic effect at all. The incidence of side effects (drowsiness, nausea, headache, or transient worsening of complaints) was rather low.
  
  
  CONCLUSIONS
  Intrathecal midazolam is a useful supplement to standard analgesic therapy with opioids, non-opioids, or spinal steroids.
authors.affiliation: Central ICU and Neurosurgical Pain Relief Service, Masaryk Hospital, Usti nad Labem, Czech Republic. jan.prochazka@mnul.cz
authors.forename: Jan
authors.initials: J
authors.lastname: Prochazka
authors.forename: Ales
authors.initials: A
authors.lastname: Hejcl
authors.forename: Lidmila
authors.initials: L
authors.lastname: Prochazkova
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D055111:Failed Back Surgery Syndrome / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007278:Injections, Spinal / Q000379:methods; D017116:Low Back Pain / Q000188:drug therapy*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000759:Adjuvants, Anesthesia; D008874:Midazolam