Intradermal therapy, known as mesotherapy, is a technique used to inject a drug into the surface layer of the skin. In particular, it involves the use of a short needle to deposit the drug in the dermis. The intradermal microdeposit modulates the drug’s kinetics, slowing absorption and prolonging the local mechanism of action. It is successfully applied in the treatment of some forms of localized pain syndromes and other local clinical conditions. It could be suggested when a systemic drug-sparing effect is useful, when other therapies have failed (or cannot be used), and when it can synergize with other pharmacological or nonpharmacological therapies. Despite the lack of randomized clinical trials in some fields of application, a general consensus is also reached in nonpharmacological mechanism of action, the technique execution modalities, the scientific rationale to apply it in some indications, and the usefulness of the informed consent. The Italian Mesotherapy Society proposes this position paper to apply intradermal therapy based on scientific evidence and no longer on personal bias.

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Cocaine abuse continues to be a major public health problem in the world. An upper numbers of individuals are initiating cocaine use with a stable rate of growth each year with an increasing number of people with cocaine related problems. Following cocaine oxidative pathways a ROS formation are generated. Oxidative stress has been demonstrated to play an important role in cocaine addiction and toxicity due to its oxidized metabolites produced by cytochrome P450 during cocaine biotransformation. The ROS induced genotoxicities include DNA damage, gene mutation, chromosome aberrations and micronuclei formation. 8-Hydroxy-2'-deoxyguanosine (8-OHdG) an oxidative modified DNA product, is the most representative product that may reflect oxidative damage induced by ROS. The present study was designed to investigate whether a systemic cocaine administration and its metabolism increase 8-OHdG production. Our findings clearly showed that cocaine promoted the ROS formation with significant increased of urinary 8-OHdG and MDA with a decreased of total scavenging capacity (TSC).

Phytochemicals are promising adjuvant agents for the treatment of pain. This study aimed to explore the short-term efficacy and safety of a fixed-dose combined therapy with Palmitoylethanolamide and other phytochemicals as add-on therapy in elderly patients. Data on 47 elderly patients with non-oncologic chronic pain of mild-moderate degree were analyzed in a retrospective, descriptive, no-profit, double-center realworld study. Patients were administered the combined phytochemical therapy for 6 weeks, in addition to analgesics administered when needed. Patients showed a reduction in pain intensity both in mixed /nociceptive and in neuropathic pain and improvements in functional abilities, quality of life, and in the subjective belief about the efficacy of treatment. These results were also observed in the small subgroup of patients in monotherapy with phytochemicals (n=13). No adverse event led to treatment withdrawal. This exploratory study suggests that phytochemicals may represent an effective source of analgesics to be added to chemically synthesized drugs, therefore reducing the need of their up-titration and the risk of toxicity. These data must be considered as preliminary and need to be tested in randomized trials.