Groundbreaking News – A “Cure” For Chronic Discogenic Back Pain??

A simple procedure injecting 1 ml of 1% methylene blue followed by 1 ml 2% lidocaine into damaged disc has achieved unprecedented results

A randomized placebo-controlled trial of intradiscal methylene blue injection for the treatment of chronic discogenic low back pain
Baogan Peng a,b,*, Xiaodong Pang a, Ye Wub, Changcheng Zhao c, Xinghua Song
Pain – in press 2010 abstract here

• Randomized placebo controlled trial
• P<0.001
• no complications
• “After the treatment, all the patients were put to bed for 24 h, and asked to avoid strenuous exercise for 3 weeks.”
• They do not specify if the methylene blue 1% was aqueous or not but I presume it was…
• “methylene blue is neurolytic, and has been used successfully to treat pruritus ani and the pain of acute fractures”
• mean pain score reduction from 72/100 t0 20/100. Ostwesry disability drop from 48 to 13.
• at 24 months – 19% complete relief, and an additional 72% with slight pain that required no meds.

Comment:

INtradiscal injection has got a boust in recent years by the advent of injecting discs with Ozone with benefit:

One article:

Minimally Invasive Oxygen-Ozone Therapy for Lumbar Disk Herniation
Cosma F. Andreula, Luigi Simonetti, Fabio de Santis, Raffaele Agati, Renata Ricci, and Marco Leonardi
AJNR Am J Neuroradiol 24:996–1000, May 2003 free full article here

Ozone generators are not cheap, but methylene blue is.

Dr. Nikolai Bogduk wrote a commentary of the article in which he questioned:

– If this were true, “Spinal surgery for low back pain will be rendered essentially obsolete”

– Does question credibility though does come from an esteemed group in China

– Wondered if it is culturally possible that patients are afraid to say they are still in pain.

– Dr. Bogduk, himself, is replicating this study and it will be great to see the results.

Peng’s group published some preliminary data on the benefits of methylene blue a couple years ago.  I took this information to our radiology department. I was told that a discogram like injection was actually very easy to do. Otherwise I was met with stony silence. Hopefully now, there might be a move to use this procedure.