J Neurol Surg A Cent Eur Neurosurg 2021; 82(02): 161-165
DOI: 10.1055/s-0040-1721015
Review Article

Intradiskal Injection of Methylene Blue for Discogenic Back Pain: A Meta-Analysis of Randomized Controlled Trials

Ming Deng#
1   Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, P. R. China
,
Hui Huang#
2   Department of Orthopedics, Hainan Provincial People's Hospital, Haikou, Hainan, P. R. China
,
Yong-gang Ma
1   Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, P. R. China
,
Yan Zhou
1   Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, P. R. China
,
Qing Chen
1   Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, P. R. China
,
Ping Xie
3   Department of Chinese Traditional Medicine, Tongren Hospital of Wuhan University, Wuhan, Hubei Province, P. R. China
› Author Affiliations

Abstract

Introduction Intradiskal injection of methylene blue has some potential in alleviating discogenic back pain. This meta-analysis aims to explore the impact of intradiskal injection of methylene blue for discogenic back pain.

Methods Several databases such as PubMed, EMbase, Web of Science, EBSCO, and Cochrane Library databases have been searched through November 2019, and randomized controlled trials (RCTs) assessing the effect of intradiskal injection of methylene blue for discogenic back pain are included.

Results Three RCTs are included in the meta-analysis. Overall, compared with control group for discogenic back pain, intradiskal injection of methylene blue remarkably decreased pain scores at 3 months (mean difference [MD] = –0.71; 95% confidence interval [CI] = –0.96 to –0.46; p < 0.00001) and 6 months (MD = –13.92; 95% CI = –22.31 to –5.54; p = 001) and Oswestry Disability Index (ODI) at 4 to 6 weeks (MD = –10.39; 95% CI = –16.95 to –3.83; p = 0.002) and 3 months (MD = –3.66; 95% CI = –4.85 to –2.48; p < 0.00001), but demonstrated no obvious effect on ODI at 6 months (MD = –11.76; 95% CI = –33.33 to 9.80; p = 0.28).

Conclusions Intradiskal injection of methylene blue can substantially decrease pain scores and improve function for discogenic back pain.

# These two authors contributed equally.




Publication History

Received: 02 July 2019

Accepted: 07 April 2020

Article published online:
21 January 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Luo L, Zhang C, Zhou Q. et al. Effectiveness of transpedicular dynamic stabilization in treating discogenic low back pain. World Neurosurg 2018; 111: e192-e198
  • 2 Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. The prevalence and clinical features of internal disc disruption in patients with chronic low back pain. Spine 1995; 20 (17) 1878-1883
  • 3 Zhou Y, Abdi S. Diagnosis and minimally invasive treatment of lumbar discogenic pain: a review of the literature. Clin J Pain 2006; 22 (05) 468-481
  • 4 Simon J, McAuliffe M, Shamim F, Vuong N, Tahaei A. Discogenic low back pain. Phys Med Rehabil Clin N Am 2014; 25 (02) 305-317
  • 5 Bogduk N, Aprill C, Derby R. Lumbar discogenic pain: state-of-the-art review. Pain Med 2013; 14 (06) 813-836
  • 6 Buirski G, Silberstein M. The symptomatic lumbar disc in patients with low-back pain. Magnetic resonance imaging appearances in both a symptomatic and control population. Spine 1993; 18 (13) 1808-1811
  • 7 Duan B, Cheng L, Ma Q. Spinal circuits transmitting mechanical pain and itch. Neurosci Bull 2018; 34 (01) 186-193
  • 8 Peng B, Wu W, Hou S, Li P, Zhang C, Yang Y. The pathogenesis of discogenic low back pain. J Bone Joint Surg Br 2005; 87 (01) 62-67
  • 9 Bertagnoli R, Yue JJ, Shah RV. et al. The treatment of disabling multilevel lumbar discogenic low back pain with total disc arthroplasty utilizing the ProDisc prosthesis: a prospective study with 2-year minimum follow-up. Spine 2005; 30 (19) 2192-2199
  • 10 Wainwright M, Crossley KB. Methylene blue: a therapeutic dye for all seasons?. J Chemother 2002; 14 (05) 431-443
  • 11 Zhang L, Liu Y, Huang Z. et al. Toxicity effects of methylene blue on rat intervertebral disc annulus fibrosus cells. Pain Physician 2019; 22 (02) 155-164
  • 12 Tan KY, Seow-Choen F. Methylene blue injection reduces pain after lateral anal sphincterotomy. Tech Coloproctol 2007; 11 (01) 68-69
  • 13 Vaccaro A, Patten SA, Ciura S. et al. Methylene blue protects against TDP-43 and FUS neuronal toxicity in C. elegans and D. rerio. PLoS One 2012; 7 (07) e42117
  • 14 Volke V, Wegener G, Vasar E, Rosenberg R. Methylene blue inhibits hippocampal nitric oxide synthase activity in vivo. Brain Res 1999; 826 (02) 303-305
  • 15 Aneese AM, Ghaith G, Cannon ME, Manuballa V, Cappell MS. EUS-guided methylene blue injection to facilitate endoscopic cannulation of an obscured pancreatic duct orifice after ampullectomy. Am J Gastroenterol 2018; 113 (05) 782-783
  • 16 Cohen SP, Williams KA, Kurihara C. et al. Multicenter, randomized, comparative cost-effectiveness study comparing 0, 1, and 2 diagnostic medial branch (facet joint nerve) block treatment paradigms before lumbar facet radiofrequency denervation. Anesthesiology 2010; 113 (02) 395-405
  • 17 Kallewaard JW, Wintraecken VM, Geurts JW. et al. A multicenter randomized controlled trial on the efficacy of intradiscal methylene blue injection for chronic discogenic low back pain: the IMBI study. Pain 2019; 160 (04) 945-953
  • 18 Zhang L. Effect of methylene blue injection on lumbar function and pain in patients with discogenic low back pain. J Nat Med 2018; 3: 312-313
  • 19 Peng B, Pang X, Wu Y, Zhao C, Song X. A randomized placebo-controlled trial of intradiscal methylene blue injection for the treatment of chronic discogenic low back pain. Pain 2010; 149 (01) 124-129
  • 20 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009; 62 (10) 1006-1012
  • 21 Jadad AR, Moore RA, Carroll D. et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials 1996; 17 (01) 1-12
  • 22 Zhao J, Huang W, Zhang S. et al. Efficacy of glutathione for patients with cystic fibrosis: a meta-analysis of randomized-controlled studies. Am J Rhinol Allergy 2020; 34 (01) 115-121
  • 23 Kjaergard LL, Villumsen J, Gluud C. Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med 2001; 135 (11) 982-989
  • 24 Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21 (11) 1539-1558
  • 25 Delport A, Harvey BH, Petzer A, Petzer JP. Methylene blue analogues with marginal monoamine oxidase inhibition retain antidepressant-like activity. ACS Chem Neurosci 2018; 9 (12) 2917-2928
  • 26 Eide PK, Hole K. The role of 5-hydroxytryptamine (5-HT) receptor subtypes and plasticity in the 5-HT systems in the regulation of nociceptive sensitivity. Cephalalgia 1993; 13 (02) 75-85
  • 27 Yaksh TL, Wilson PR. Spinal serotonin terminal system mediates antinociception. J Pharmacol Exp Ther 1979; 208 (03) 446-453
  • 28 Mentes BB, Akin M, Leventoglu S, Gultekin FA, Oguz M. Intradermal methylene blue injection for the treatment of intractable idiopathic pruritus ani: results of 30 cases. Tech Coloproctol 2004; 8 (01) 11-14
  • 29 Farrokhi MR, Lotfi M, Masoudi MS, Gholami M. Effects of methylene blue on postoperative low-back pain and functional outcomes after lumbar open discectomy: a triple-blind, randomized placebo-controlled trial. J Neurosurg Spine 2016; 24 (01) 7-15
  • 30 Peng B, Zhang Y, Hou S, Wu W, Fu X. Intradiscal methylene blue injection for the treatment of chronic discogenic low back pain. Eur Spine J 2007; 16 (01) 33-38
  • 31 Kallewaard JW, Geurts JW, Kessels A, Willems P, van Santbrink H, van Kleef M. Efficacy, safety, and predictors of intradiscal methylene blue injection for discogenic low back pain: results of a multicenter prospective clinical series. Pain Pract 2016; 16 (04) 405-412
  • 32 Levi DS, Horn S, Walko E. Intradiskal methylene blue treatment for diskogenic low back pain. PM R 2014; 6 (11) 1030-1037