Confirmed – Intrathecal (Spinal) Midazolam Gives 1-3 Months Relief in Chronic and Failed Back Pain

Those who have epidural steroid injections for back pain know they are limited often to injections every 3 months (except for initial 3 shots). When the pain comes back in 3-6 weeks – what can one do? Now it looks like Spinal Midazolam can fill the gap…

I had previously promoted this as an option –

Midazolam Augmentation of Lumbar Steroid Injections – Use, in Just Mechanical Back Pain

Now its effectiveness has been proven:

Fourteen Years of Experience with Intrathecal Midazolam in Chronic Low Back Pain – 459 Administrations
Jan Prochazka
IASP poster 425 Montreal 2010

• 80 cases low back pain; 379 failed back surgery syndrome – 14 years experience!
• ages 28-86; average 49.9
• Started with 2 mg preservative free midazolam and worked up to 5 mg – most were evenly split between 2, 3 and 4 mg with maybe 10% at 5 mg.
• My thought – Making preservative free versed should be quite simple – mix it with 1-2 mls IV sodium bicarbonate in a syringe. Let it stand in fridge with needle end up. Since modazolam is insoluble over ph 3.5, will precipitate and preservative can be injected off, leaving precipitated Versed on plunger.
  Adding lidocaine will re-dissolve it as lidocaine HCL as low ph. Alternately, it could be mixed with saline and injected as suspension, perhaps in 10 mls (note – haven’t tried it- so if someone does let me know if works well…) Or better yet, just neutralize with bicarb 8.4% and dilute with 10 cc local or saline.
• Over 60% got relief for an average of 9.9 weeks
• Most cases had had 4-5 injections over time
• Initially, they monitored BP, HR and Oximetry but never had any abnormalities.
• Cases were watched for up to 3 hours but “incidence of side effects (drowsiness, nausea, headache, or transient worsenng of complaints) was low.”
• cases were supplemented with opioids

Comment – was so impressed with what was obviously a life’s work I had to shake his hand. His publishing of results will require translation so could take some time…