Intradiskal Methylene Blue Treatment for Diskogenic Low Back Pain

Levi, David; Horn, Scott; Walko, Edward

doi:10.1016/j.pmrj.2014.04.008

Cited by 9 publications

(12 citation statements)

References 25 publications

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“…They concluded that the intradiscal MB injection is a minimally invasive treatment that is effective in the short term and is indicated for discogenic back pain but may lose its effectiveness long term. In a study with findings that are in contrast to ours, Levi et al 23 used a single intradiscal injection of MB in patients with discogenic LBP and found no improvement in pain. The difference between their findings and ours might be explained by the small sample size (16 patients) used in their study.…”

Section: Discussioncontrasting

confidence: 89%

“…33 The second study was a randomized placebo-controlled trial of intradiscal injection of 1 ml of 1% MB for the treatment of chronic discogenic LBP and demonstrated a reduction in the mean disability score from 48 to 13 after MB treatment and a definite improvement in physical function. 32 Levi et al 23 investigated the change in ODI score in patients with discogenic LBP after a single intradiscal injection of MB; they considered 30% improvement in function as the categorical success rate and less than 30% as the categorical failure. They reported that for the ODI, at 1, 2 and 6 months after the injection, the categorical success rates were 25%, 21%, and 33%, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Effects of methylene blue on postoperative low-back pain and functional outcomes after lumbar open discectomy: a triple-blind, randomized placebo-controlled trial

Farrokhi¹,

Lotfi

Masoudi³

et al. 2016

SPI

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OBJECT Despite advances in surgical and anesthesiology techniques, many patients continue to experience postoperative pain after lumbar disc operations. This study aims to investigate the effects of methylene blue (MB) on preventing postoperative low-back pain (LBP) with or without radicular pain and improving the quality of life (QOL) in patients undergoing lumbar open discectomy. METHODS This is a prospective, randomized, triple-blind, placebo-controlled clinical trial, which was conducted at Shiraz University of Medical Sciences between July 2011 to January 2012. Of a total of 130 patients, 115 were eligible for participation; 56 received 1 ml of MB solution at a concentration of 0.5% (MB group) and 59 received an equivalent volume of normal saline (control group). Primary outcomes were the control of LBP with or without radicular pain, which was evaluated preoperatively and at 24 hours and 3 months after surgery with the use of a visual analog scale (VAS), and the improvement of QOL, which was assessed preoperatively and 3 months postoperatively by means of the Persian translation of the Oswestry Disability Index questionnaire. RESULTS The mean VAS scores for LBP were significantly lower in the MB group compared with the control group at 24 hours (1.25 ± 0.97 vs 2.80 ± 0.69, p < 0.001) and 3 months (1.02 ± 1.29 vs 2.07 ± 1.10, p = 0.019) after treatment. The mean radicular pain scores decreased significantly in the 2 groups at 24 hours after surgery, but the mean radicular pain score was significantly lower in the MB-treated patients than the control group. However, the difference between radicular pain scores in the MB group (1 ± 1.1) and the control group (1.2 ± 1) was not statistically significant (p = 0.64). The reduction in LBP was greater in the MB group than the control group (8.11 ± 1.74 vs 6.07 ± 1.52, p = 0.023, CI 95% −1.37 to −0.10). The functional QOL improved significantly 3 months after the operation in both groups (p < 0.001). Moderate disability occurred more frequently in the control group than in the MB group (14.5% vs 7.7%, p = 0.004). No toxicity, adverse effects, or complications were found in the group of patients treated with MB injection. CONCLUSIONS A single dose of MB (1 ml 0.5%) for coating the dura and surrounding tissues (facet and muscle) shows promising results in terms of safety, reduction of postoperative pain, and functional outcome compared with placebo.

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Section: Discussioncontrasting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Effects of methylene blue on postoperative low-back pain and functional outcomes after lumbar open discectomy: a triple-blind, randomized placebo-controlled trial

Farrokhi¹,

Lotfi

Masoudi³

et al. 2016

SPI

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“…reported a clinical trial with a cohort of eight patients with mental health issues, and their results revealed a success rate of only 13%, in contrast to the outcomes reported by Peng et al . In 2014, Levi et al . defined success as improvement of at least 30% on the VAS accompanied by improvement of at least 30% on the ODI, and they found that the success rate was only 19%, 21%, and 25% for the 1‐, 2‐, and 6‐month follow‐up times, respectively.…”

Section: Discussionmentioning

confidence: 94%

“…One study was a clinical RCT, but we extracted the data for the intradiscal MB injection group only. Another study included 16 cases, but the follow‐up data were incomplete; thus, complete data were extracted for only 8 cases. The characteristics of the five studies are described in Table .…”

Section: Resultsmentioning

confidence: 99%

“…The initial search identified 284 articles; following removal of duplicates, screening of titles and abstracts identified 19 potential studies. After a detailed review of full text of retrieved studies, eight articles 21,22,[24][25][26]28,29,34 met the inclusion criteria and five 21,22,24,26,34 (Figure 1) of these were eligible for inclusion in this meta-analysis. The most prevalent reasons for exclusion were invalid reference, incomplete data, and the absence of follow-up.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Intradiscal Methylene Blue Injection for Discogenic Low Back Pain: A Meta‐Analysis

Ding

Liu

et al. 2018

Pain Practice

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Leaping the hurdles in developing regenerative treatments for the intervertebral disc from preclinical to clinical

et al. 2018

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Chronic back and neck pain is a prevalent disability, often caused by degeneration of the intervertebral disc. Because current treatments for this condition are less than satisfactory, a great deal of effort is being applied to develop new solutions, including regenerative strategies. However, the path from initial promising idea to clinical use is fraught with many hurdles to overcome. Many of the keys to success are not necessarily linked to science or innovation. Successful translation to clinic will also rely on planning and awareness of the hurdles. It will be essential to plan your entire path to clinic from the outset and to do this with a multidisciplinary team. Take advice early on regulatory aspects and focus on generating the proof required to satisfy regulatory approval. Scientific demonstration and societal benefits are important, but translation cannot occur without involving commercial parties, which are instrumental to support expensive clinical trials. This will only be possible when intellectual property can be protected sufficiently to support a business model. In this manner, commercial, societal, medical, and scientific partners can work together to ultimately improve patient health. Based on literature surveys and experiences of the co‐authors, this opinion paper presents this pathway, highlights the most prominent issues and hopefully will aid in your own translational endeavors.

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Intradiskal Methylene Blue Treatment for Diskogenic Low Back Pain

Abstract: This small trial did not demonstrate overall clinical success of intradiskal methylene blue injection for patients diagnosed with diskogenic pain by diskography.

Cited by 9 publications

References 25 publications

Effects of methylene blue on postoperative low-back pain and functional outcomes after lumbar open discectomy: a triple-blind, randomized placebo-controlled trial

Effects of methylene blue on postoperative low-back pain and functional outcomes after lumbar open discectomy: a triple-blind, randomized placebo-controlled trial

Intradiscal Methylene Blue Injection for Discogenic Low Back Pain: A Meta‐Analysis

Leaping the hurdles in developing regenerative treatments for the intervertebral disc from preclinical to clinical

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