Intradermal mesotherapy versus systemic therapy in the treatment of musculoskeletal pain: A prospective randomized study
Introduction
Acute musculoskeletal injuries are one of the most common painful presentations for admission to the emergency department (ED), and it is estimated to compose up to 10% of ED visits [1,2]. Pain control is an essential component of management of patients with acute injury and other acute visits to ED. Acute visits to ED can induce anxiety and fear, which are due to the unplanned nature of patient attendance, which can exacerbate the experience of pain intensity [1]. Therefore, pain management provides reduced anxiety and fear, improved patient satisfaction and patient comfort [3].
Systemic pharmacological drugs are the mainstay of therapy for pain control in patients with acute injury [4]. Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are the most commonly prescribed medications for providing pain relief, the addition of an opioid analgesic is often necessary for more severe pain in patients with cancer or postoperative pain [4,5]. NSAIDs, which are commonly used to control the musculoskeletal pain, have substantial side effects, especially in patients with underlying health problems [2]. They can lead to serious gastrointestinal (GI), cardiac and renal complications, particularly if taken inappropriately [2]. NSAIDs are generally believed to be safe, people do not have enough information about NSAIDs and their side effects, are commonly used above recommended dose or used concomitantly with other drugs [6]. They are also easily accessible over the counter drugs, and higher dose can be purchased with a medical prescription and these factors contribute to the risk of adverse effects. The Food and Drug Administration and multiple medical societies specify that NSAIDs should be used at the lowest effective dose for the shortest duration needed to achieve a therapeutic effect [6].
Local pharmacological therapy, if effective and reliable, represents an acceptable alternative to systemic NSAIDs for the treatment of musculoskeletal injury [7]. Mesotherapy is the practice of using microinjections of medications into the superficial layer of the skin to treat pain in a specific part of body [8]. The objective of mesotherapy is to modulate the pharmacokinetics of the injected substance and to provide the prolonged effects with intradermal injections of small amount of active substance at the applied area [7]. On the other hand, a local pharmacological effect can be achieved without the need for high systemic concentration [9]. The efficacy of mesotherapy, particularly in the treatment of chronic musculoskeletal pain, was evaluated in a review published by Mammucari et al. and they concluded overall results suggest that mesotherapy provides clinical benefits and more importantly is well tolerated [7]. It was studied in patients with arthritis, with low back pain, with cervicobrachialgia, with gonarthrosis, with calcific tendinitis and with carpal tunnel syndrome [7,8]. Multiple mesotherapy sessions were used in these patients suffering chronic pain [7]. The aim of the presented study was to evaluate the effects of one-session application of tenoxicam mesotherapy for pain control, in patients with acute musculoskeletal injury.
Section snippets
Study design and setting
The study was designed as a prospective parallel randomized controlled trial using restricted randomization via Random Allocation Software (RAS) [10], with random permuted blocks of 4 and an allocation ratio of 1:1 according to the CONSORT guidelines [11]. The study was carried out in accordance with the Declaration of Helsinki. Following the approval of the Clinical Research Ethics Committee of the Atatürk University on 19.09.2018, the study was conducted at Emergency Department of the Atatürk
Results
The study was conducted with the patients admitted to ED with acute musculoskeletal injury. A total of 9208 patients who admitted with any complaint to ED were enrolled and assessed for eligibility in the study. After excluding 9112 patients, 96 patients were randomized into the mesotherapy group and the systemic therapy group. In the mesotherapy group, 10 patients withdrew from study just after allocation (before the treatment), because they were informed about that they were allocated to the
Discussion
The steady increase in overall ED visits has been reported in United States and most of ED visits are due to patients seeking relief from their pain [4,[15], [16], [17]]. A systematic review -most of the trials included are observational studies and some of them are randomized studies- and several published trials support that the mesotherapy could be a valuable therapeutic option in the treatment of painful conditions, and most of our knowledge on mesotherapy results from the studies that
Limitations
Our study has several notable limitations. As mentioned above our study includes a small number of young patients and our results are not generalizable to older people or people with chronic health conditions. The mesotherapy was applied for one session in our study and our patients were observed for a short follow-up period. Multiple doses of mesotherapy provide an opportunity to perform extended observation periods. The use of a mixture of drugs for local therapy is a concern due to the
Conclusions
The ultimate aim of pain management in acute musculoskeletal injury is to reduce pain. Reducing patient's anxiety, shortening hospital stay, enhancing patient satisfaction and quality of life are secondary gains of the pain management. Our results suggest that the response to the mesotherapy may be superior than the systemic therapy in the short term follow up. This alternative therapy could be a reliable option as a complementary treatment in an overall treatment planning in patients with
Acknowledgements
The author thanks Meryem BETOS KOCAK, MD for performing mesotherapy procedures, and for comments that greatly improved the manuscript.
Declaration of interest statement:
The author declares no competing interests to disclose.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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