Intradiscal Methylene Blue Injections May Not Be Effective for Chronic Low Back Pain

Intradiscal Methylene Blue
Intradiscal Methylene Blue
Intradiscal methylene blue injection was not found to alleviate pain in patients with chronic diskogenic low back pain.

Intradiscal methylene blue injection was not found to alleviate pain in patients with chronic diskogenic low back pain (CD-LBP), according to a study published in PAIN.

Researchers sought to replicate the results from a multicenter double blind trial published in 2010, in which intradiscal methylene blue injections were found to reduce pain intensity and improve overall health in patients with CD-LBP.

A total of 81 patients with CD-LBP (age 22-65 years) treated at 4 interventional pain centers were randomly assigned to receive 1 mL methylene blue plus 0.5 mL lidocaine hydrochloride 2% (n=40) or 1 mL isotonic saline plus 0.5 mL of lidocaine hydrochloride 2% (n=41). Study participants were assessed at baseline, at 6 weeks, and at 3 and 6 months. Baseline characteristics were similar between groups. The trial’s primary outcome was average pain at 6 months, self-assessed by participants 3 times daily over 4 days using a numeric rating scale.

A total of 25 patients from the entire cohort (30.9% ) reported a reduction ≥30% at 6 months from baseline levels, including 14 patients who had received methylene blue injections and 11 patients in the placebo group (P =0.43). Overall health was reported to be “much” or “very much” improved by 25% and 24.4% of participants treated with methylene blue and placebo, respectively, 6 months after treatment (P =0.96). Pain reduction of ≥30% combined with “much” or “very much” improved health was reported by 22.5% and 19.5% of participants who had received methylene blue and placebo, respectively.

The researchers reported small sample size as a limitation of their study.

“Our results do not support the recommendation of using intradiscal [methylene blue] injection as a treatment therapy of choice for patients with [CD-LBP],” concluded the study authors. “We recommend further research to study the exact mechanism of [CD-LBP] and to define the specific characteristics of [patients with CD-LBP] to determine whether intradiscal injections may be a treatment option.”

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Kallewaard JW, Wintraecken VM, Veerle M, et al. A multicenter randomized controlled trial on the efficacy of intradiscal methylene blue injection for chronic discogenic low back pain: The IMBI study [published online January 3, 2019]. PAIN. doi: 10.1097/j.pain.0000000000001475