PainSci summary of 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 at the bottom of the page, as often as possible. ★★★★★5-star ratings are for sentinel studies, excellent experiments with meaningful results. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
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.
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,” Soo-Hyun Kim, Sang-Ho Ahn, Yun-Woo Cho, and Dong-Gyu Lee, 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,” Jan Willem Kallewaard, Veerle M Wintraecken, José W Geurts, Paul C Willems, Henk van Santbrink, Chris T M Terwiel, Maarten van Kleef, and Sander M J van Kuijk, Pain, 2019.
Specifically regarding Peng 2010:
- “A cure for back pain?,” Nikolai Bogduk, Pain, 2010.
One article on PainScience.com cites Peng 2010 as a source:
- PS Save Yourself from Low Back Pain! — Low back pain myths debunked and all your treatment options reviewed
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:
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.
- The neck and headaches. Bogduk 2014 Neurol Clin.
- Agreement of self-reported items and clinically assessed nerve root involvement (or sciatica) in a primary care setting. Konstantinou 2012 Eur Spine J.
- Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. Morelli 2017 Am J Sports Med.
- Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. Paige 2017 JAMA.