A cure for back pain? Review of intradiscal methylene blue study
Monday, January 17, 2011 at 1:28PMA study by Peng et al.[i] announced in a 2010 publication of Pain "astounding results, unprecedented and unrivaled in the history of research into the treatment of chronic discogenic low back pain."[ii]
Those are big words, especially considering they are coming from a commentary by Nikolai Bogduk a pre-eminent expert in the area of back pain and biomedical sciences. Bogduk continues, “If the results of Peng et al. [iii] are true, this intervention will revolutionize the treatment of low back pain. Spinal surgery for back pain will be rendered essentially obsolete.” [iv]
So what did Peng et al. do that was so revolutionary? The treatment was simply an injection of 1mL of 1% methylene blue and 1mL of 2% lidocaine into disc presumed to be pain generators. 19% of the study participants reported having complete pain relief. 72% reported only having slight pain that required no medication. [v] Those are results that lots of other interventions have a hard time standing up against.
Discogram injection procedure
So why would intradiscal blue dye be helpful? It is hard to know for sure. Methylene blue is known to be an “inhibitor of nitric oxide-induced guanylate cyclase and nitric oxide has been implicated in the inflammatory processes of disc degeneration and discogenic pain.” [vi]
All this sounds very promising. This study, though, is an initial study and bears some follow-up. If the results are replicated, though, by other centers then this could be a promising treatment for a large group of people living with back pain.
The people that would seem to benefit most would be individuals with axial (low back rather than leg) pain, symptoms generally worse with sitting (or lumbar flexion), and pain not improved by more conservative interventions. We will all be waiting for replication of this data.
[i] Pain. 149 (2010): 124-129
[ii] Bogduk. Pain. 149 (2010): 7-8
[iii] Pain. 149 (2010): 124-129
[iv] Bogduk. Pain. 149 (2010): 7-8
[v] Pain. 149 (2010): 124-129
[vi] Bogduk. Pain. 149 (2010): 7-8
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