Background Chronic low back pain is a common painful medical problem which has significant socioeconomic impact. Conventional pharmacological therapy usually associated with adverse effects. Mesotherapy is a minimally invasive technique done by subcutaneous injections of drugs, plant extracts, homeopathic agents, or other bioactive substance .
Objectives To evaluate the value of mesotherapy, either by traditional drugs or by bee venom, as a therapeutic modality for management of chronic low back pain and compare it versus conventional systemic administration of nonsteroidal anti-inflammatory drugs and corticosteroids for patients with chronic low back pain.
Methods A randomized controlled clinical trial with three parallel arms carried out at the Department of Rheumatology and Rehabilitation -Faculty of Medicine, Fayoum University in Egypt.The study was assessed and approved by the Faculty of Medicine Fayoum University Ethics Committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. One hundred and twenty (120) patients (both sexes) aged 19– 65 years and suffering from back pain since more than 3 months and reported a current pain intensity >60 on a 100mm visual analogic scale. Patients are randomly allocated to be divided to three main groups: Group I: 40 patients received drug therapy according to the following protocol: ketoprofen 150 mg /day orally for 12 days + methylprednisolone (MP) intramuscularly 40 mg/day for the first 4 days, then 20mg/day for 3 days, then 20 mg/day at alternate days + esomeprazole 20 mg/die for 12 days. Group II: 40 patients received: 2% lidocaine (1 mL) + ketoprofen 100 mg (2 mL) + MP 40 mg (1 mL) at day 1 and 4, then 2% lidocaine (1 mL) + ketoprofen 100 mg (2mL) + MP 20 mg (0.5 mL) day 7, 10, and 13, five repeated injections. Group III: 40 patients received (0.5 mL) diluted purified bee venom + 2% lidocaine (0.5 mL) twice weekly for three weeks. Pain intensity and functional disability were assessed at baseline (T0), at the end of treatment (T1), and 6 months thereafter (T2) by using visual analogic scale (VAS) and Roland-Morris disability questionnaire (RMDQ).
Results In the three groups, VAS and RMDQ values were significantly reduced at the end of drug treatment and after 6 months, in comparison with baseline. there was no significant difference in mean basal VAS and RMDQ scores between three groups, at the end of treatment (T1) but mean VAS and RMDQ scores level in group II showed significant decrease than G I and G III (p value <0.05). At T3, the mean VAS and RMDQ scores showed further decrease in GII in comparison with GI and GIII.
Conclusions Mesotherapy by using conventional drugs; NSAIDs and corticosteroids or by bee venom is an effective and well-tolerated method for managing low back pain in the short-term, and may be a valid alternative to conventional therapy in the treatment of low back pain with corticosteroids and NSAIDs.
Costantino C, Marangio E and Coruzzi G: Mesotherapy versus Systemic Therapy in the Treatment of Acute Low Back Pain: A Randomized Trial. Evid Based Complement Alternat Med. 2011; 2011. pii: 317183. doi: 10.1155/2011/317183. Epub 2010 Sep 1.
Acknowledgements Abdelwahab Khalil Abdelwahab, Sera Plant, Egyptien serum and vaccine company (VACSERA)
Disclosure of Interest None declared