Back pain 'cure' awaits confirmation

Reports of an apparently revolutionary cure for low back pain based on intradiscal injections of methylene blue should be taken with a pinch of salt, an Australian rheumatologist says. Preliminary findings from a randomised trial to be published in the journal Pain show that injection of 1ml of methylene blue and 1ml of 2% lignocaine resulted in resolution of symptoms in 20% of patients and a further 72% of patients having only slight pain after 24 months. The ‘number needed to treat’ to achieve a cure was two. The results, from an ‘esteemed’ research group at a Beijing orthopaedics hospital, would have major implications for the treatment of back pain if confirmed, says Professor Nik Bogduk of the University of Newcastle Bone and Joint Institute in an accompanying editorial. “Against these figures, the results of surgery, rehabilitation, behavioural therapy and any other treatment for back pain pale into insignificance … spinal surgery for back pain will be rendered obsolete,” he writes. The mechanism may be related to methylene blue being an inhibitor of nitric oxide-induced guanylate cyclase, and NO being implicated in the inflammatory process of disc degeneration and discogenic pain, he notes. However, he warns that any move to adopt the seemingly simple and inexpensive technique should await confirmation by other groups. There may be genetic or cultural factors to explain the favourable outcomes seen in Chinese patients, he says. Professor Bogduk says he will be embarking upon a replication study and comments that "For ridding the world of back pain, this styudy would be worthy of the Nobel Prize if the results are true.”...