Surprisingly effective back pain injection: intradiscal methylene blue
One article on PainSci cites Peng 2010: The Complete Guide to Low Back Pain
PainSci commentary on Peng 2010: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
This startling experiment shows strong evidence that the injection of methylene blue into a painful disc is a “safe, effective and minimally invasive” method for the treatment of discogenic low back pain, far more effective than any other known treatment for low back pain. The surprising results — 19% completely free of pain, and 72% almost so — were published in April in the prestigous journal Pain, by a credible research group. In an editorial in the same issue, low back pain expert Nikolai Bogkduk (see Bogduk) expresses every reasonable caution against premature celebration, yet judges that “there are no lethal flaws in the study” and calls it “one of the most incredible studies of a low back pain treatment ever published.” He describes the results as “astounding, unprecedented and unrivalled in the history of research into the treatment of chronic discogenic low back pain. The results of surgery, rehabilitation, behavioural therapy, and any other treatment for back pain pale into insignificance.”
Methylene blue is essentially just an anti-inflammatory medication well-tuned for the chemistry of irritated intervertebral discs. (Another theory is that it actually destroys some small nerve fibers that have overgrown in the disc.)
If the results of Peng et al are true, this intervention will revolutionize the treatment of low back pain. Spinal surgery for back pain will be rendered essentially obsolete. Furthermore, and ironically, the treatment is not subject to any patent, and is readily available. Anyone who performs discography will be able to provide the treatment, at trivial extra cost. For ridding the world of back pain, this study would be worthy of nomination for a Nobel Prize; if the results are true.
These very positive results have been at least partially replicated since, by Kim et al.
There was clear failure to replicate in 2019: see Kallewaard.
~ Paul Ingraham
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
A preliminary report of clinical study revealed that chronic discogenic low back pain could be treated by intradiscal methylene blue (MB) injection. We investigated the effect of intradiscal MB injection for the treatment of chronic discogenic low back pain in a randomized placebo-controlled trial. We recruited 136 patients who were found potentially eligible after clinical examination and 72 became eligible after discography. All the patients had discogenic low back pain lasting longer than 6 months, with no comorbidity. Thirty-six were allocated to intradiscal MB injection and 36 to placebo treatment. The principal criteria to judge the effectiveness included alleviation of pain, assessed by a 101-point numerical rating scale (NRS-101), and improvement in disability, as assessed with the Oswestry Disability Index (ODI) for functional recovery. At the 24-month follow-up, both the groups differed substantially with respect to the primary outcomes. The patients in MB injection group showed a mean reduction in pain measured by NRS of 52.50, a mean reduction in Oswestry disability scores of 35.58, and satisfaction rates of 91.6%, compared with 0.70%, 1.68%, and 14.3%, respectively, in placebo treatment group (p<0.001, p<0.001, and p<0.001, respectively). No adverse effects or complications were found in the group of patients treated with intradiscal MB injection. The current clinical trial indicates that the injection of methylene blue into the painful disc is a safe, effective and minimally invasive method for the treatment of intractable and incapacitating discogenic low back pain.
- “Effect of Intradiscal Methylene Blue Injection for the Chronic Discogenic Low Back Pain: One Year Prospective Follow-up Study,” Kim et al, Ann Rehabil Med, 2012.
- “A multicenter randomized controlled trial on the efficacy of intradiscal methylene blue injection for chronic discogenic low back pain: the IMBI study,” Kallewaard et al, Pain, 2019.
Specifically regarding Peng 2010:
- “A cure for back pain?,” Bogduk, Pain, 2010.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Inciting events associated with lumbar disc herniation. Suri 2010 Spine J.
- Prediction of an extruded fragment in lumbar disc patients from clinical presentations. Pople 1994 Spine (Phila Pa 1976).
- Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study. Konstantinou 2015 BMC Musculoskelet Disord.
- Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Kuyken 2022 Evid Based Ment Health.
- Is there a relationship between throbbing pain and arterial pulsations? Mirza 2012 J Neurosci.