Here is a lesson in evidence-based pain management. Researchers reported that intrathecal midazolam, a benzodiazepine, was a beneficial supplement to standard analgesic therapy for recalcitrant lower-back pain. However, because of the study design and limited data this is not valid evidence of treatment effects, which raises questions about why this study was published.
Writing in the journal Pain Medicine, Jan Prochazka, MD, and colleagues from the Czech Republic describe a prospective, observational, open-label investigation of single-dose intrathecal administration of midazolam (off-label) in patients with chronic low-back pain or failed back surgery syndrome [Prochazka et al. 2011]. The primary outcome measure was pain relief determined by a patient questionnaire during subsequent visits to the pain therapy clinic. A positive analgesic-effect result was considered at least 50% pain reduction along with improved quality of life and functionality.