Department of Pain, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
Pain Physician. 2022 Jan;25(1):E15-E26.
Lumbar facet joint syndrome (LFJS) has been suggested to be a main source of low back pain. Methylene blue (MB), an inhibitor of nitric oxide synthesis with potential analgesic and anti-inflammatory properties, has been widely applied for a variety of pain-related diseases. However, no studies have been conducted on the treatment of LFJS patients using MB.
The purpose of this study was to evaluate the therapeutic effects of intra-articular injection of MB on LFJS patients.
A prospective, randomized, controlled clinical trial.
Department of pain, Shanghai East Hospital.
A total of 120 eligible patients with LFJS were randomly divided into an MB group and a control group. Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9) were used to evaluate the pre-operation and post-operation states of the patients, and adverse events were recorded. The patients participating in this study were followed up for a period of 6 months.
A total of 104 patients were followed up for the entire 6 months period. The control group included 51 patients, and the MB group included 53 patients. In both groups, the NRS scores, ODI scores, PHQ-9 scores, and PSQI scores decreased at different time points after treatment, compared to baseline. Moreover, the NRS scores were significantly lower than that of the control group at 3 months and 6 months after operation (P < 0.05). The ODI, PSQI, and PHQ-9 scores of the MB group were also respective significantly lower than that of the control group at 3 months and 6 months after operation (P < 0.05). As for the clinical efficacy, the total effective treatment rate of the MB group was significantly higher than that of the control group at 6 months after the procedure (P < 0.05). On the first day after operation, the incidence of hyperglycemia in patients with diabetes in the MB group was significantly lower than that of the control group (P < 0.05).
Firstly, the patients enrolled were recruited from a single center, and the sample size was small. Secondly, the patients were only followed-up for a period of 6 months after treatment. Thirdly, double blinding was not used in the design of this research study.
Ultrasound-guided intra-articular MB injection is a safe and effective therapy for patients with LFJS. Intra-articular injection with MB can significantly reduce pain intensity, improve patient lumbar function, pain-related depression and sleep quality, increase total effective rate with no severe adverse side effects.
腰椎小关节综合征（LFJS）被认为是腰痛的主要来源。亚甲蓝（MB）是一种一氧化氮合成抑制剂，具有潜在的镇痛和抗炎作用，已广泛应用于各种与疼痛相关的疾病。然而，目前尚无研究应用 MB 治疗 LFJS 患者。
本研究旨在评估关节内注射 MB 治疗 LFJS 患者的疗效。
前瞻性、随机、对照临床试验。
上海东方医院疼痛科。
共纳入 120 例符合条件的 LFJS 患者，随机分为 MB 组和对照组。采用数字评分量表（NRS）、Oswestry 功能障碍指数（ODI）、匹兹堡睡眠质量指数（PSQI）、患者健康问卷-9（PHQ-9）评估患者术前和术后状态，并记录不良事件。所有患者均随访 6 个月。
共有 104 例患者完成了整个 6 个月的随访。对照组 51 例，MB 组 53 例。两组患者治疗后不同时间点 NRS 评分、ODI 评分、PHQ-9 评分和 PSQI 评分均较基线下降，且术后 3 个月和 6 个月时 MB 组 NRS 评分明显低于对照组（P < 0.05）。术后 3 个月和 6 个月时，MB 组 ODI、PSQI 和 PHQ-9 评分也明显低于对照组（P < 0.05）。临床疗效方面，术后 6 个月 MB 组总有效治疗率明显高于对照组（P < 0.05）。术后第 1 天，MB 组糖尿病患者高血糖发生率明显低于对照组（P < 0.05）。
首先，纳入的患者均来自单一中心，样本量较小。其次，患者仅在治疗后随访 6 个月。第三，本研究设计未采用双盲法。
超声引导下关节内 MB 注射治疗 LFJS 患者安全有效。关节内注射 MB 可显著减轻疼痛强度，改善患者腰椎功能，减轻与疼痛相关的抑郁和睡眠质量，提高总有效率，无严重不良反应。
