Akbas I, Kocak AO, Kocak MB, et al. Comparison of intradermal mesotherapy with systemic therapy in the treatment of low back pain: A prospective randomized study. Am J Emerg Med. 2019 Dec 9. pii: S0735-6757(19)30785-5. doi: 10.1016/j.ajem.2019.11.044. (Original study)

INTRODUCTION: Musculoskeletal pain such as low back pain (LBP) are routinely encountered in the ED and contribute to ED overcrowding. The aim of our study was to compare the efficiency of mesotherapy with systemic therapy in pain control in patients with lumbar disk herniation.

METHODS: We conducted this prospective parallel randomized controlled trial with the patients admitted to the emergency department with low back pain related to herniated lumbar disk. Mesotherapy was performed to one group, while intravenous dexketoprofen was administered to the control group. Changes in pain intensity at 15th minute, 30th minute, 60th minute and 24th hours after treatment using Visual Analogue Scale (VAS), need to use analgesic drug within 24 h after treatment, and adverse effect of the treatment methods were compared between groups.

RESULTS: The decreases in pain intensity were statistically significantly higher in mesotherapy group for all time intervals. The need to use analgesics was statistically significantly three fold higher in the systemic therapy group. There was no statistically significant difference in having any adverse effect between study groups during one-week follow-up period.

CONCLUSIONS: Changes in medical practices, from the systemic administration of NSAIDs to the minimally invasive techniques such as mesotherapy with potent efficacy and minimal side effects, may enhance the ability of EDs to meet the waiting time targets and improve patient's satisfaction.

Discipline Area Score
Physician 5 / 7
Comments from MORE raters

Physician rater

It's interesting that the homeopathic treatment of mesotherapy achieved publication in Ann Emerg Med. There are many issues to be considered when assessing the conclusions of this study that question the validity. The population, lack of blinding, sample size, potential for bias at several levels mean this study does not persuade me to recommend mesotherapy for ED patients with back pain, yet.

Physician rater

This is very useful information for a significant clinical issue.

Physician rater

The small sample size is surprising with multiples pain intensity measures and two main outcomes. There is no justification for using an effect size of 0.3 in the sample size calculation. No sham mesotherapy; this could be only placebo effect.
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