ABSTRACT
BACKGROUND: Low back pain (LBP) is a common health problem and a substantial part of LBP is presumed to be attributable to degeneration of the intervertebral disc. For patients suffering from intractable discogenic LBP, there are few evidence-based effective interventional treatment options available. In 2010, the results of a randomized controlled trial (RCT) were published concerning "intradiscal methylene blue injection" (IMBI), in which this intervention appeared to be very successful in relieving discogenic pain. Therefore, we decided to repeat this study to investigate whether we could replicate the published results. The results of our preliminary feasibility study gave reason to set up an RCT. The aim of this RCT is to evaluate if IMBI is a more effective treatment of discogenic low back pain as an intradiscal placebo intervention, and furthermore, to assess the cost-effectiveness of this intervention. METHODS/DESIGN: Consecutive discogenic low back pain patients referred to four specialized pain treatment facilities are being screened for eligibility. After a positive standardized provocation discography and informed consent, patients are randomized into two groups. The treatment group receives an intradiscal injection with methylene blue, lidocaine, and contrast, and the control group receives intradiscal isotonic saline with lidocaine and contrast. Main outcome measures are pain at the 6-month follow-up, patient's global impression of change, cost-effectiveness, quality of life, disability, and analgesic intake. DISCUSSION: The importance of this study is emphasized by the fact that for intractable discogenic low back pain patients, evidence-based effective pain treatments are rare. If this study establishes clinical success and cost-effectiveness, IMBI could become the "pain treatment of choice" for a selected group of patients with chronic discogenic low back pain for whom noninvasive treatment options have failed. TRIAL REGISTRATION: National Trial register NTR2547 Registered at 29 September 2010 and 31 March 2014.
Subject(s)
Analgesics/administration & dosage , Analgesics/economics , Chronic Pain/drug therapy , Chronic Pain/economics , Drug Costs , Intervertebral Disc Degeneration/drug therapy , Intervertebral Disc Degeneration/economics , Intervertebral Disc/drug effects , Low Back Pain/drug therapy , Low Back Pain/economics , Methylene Blue/administration & dosage , Methylene Blue/economics , Analgesics/adverse effects , Anesthetics, Local/administration & dosage , Anesthetics, Local/economics , Chronic Pain/diagnosis , Chronic Pain/physiopathology , Clinical Protocols , Cost-Benefit Analysis , Disability Evaluation , Double-Blind Method , Drug Combinations , Humans , Injections, Intralesional , Intervertebral Disc/physiopathology , Intervertebral Disc Degeneration/diagnosis , Intervertebral Disc Degeneration/physiopathology , Lidocaine/administration & dosage , Lidocaine/economics , Low Back Pain/diagnosis , Low Back Pain/physiopathology , Methylene Blue/adverse effects , Netherlands , Pain Measurement , Patient Satisfaction , Quality of Life , Research Design , Surveys and Questionnaires , Time Factors , Treatment OutcomeABSTRACT
We report a surgical case of ectopic mediastinal parathyroid tumor resected by video-assisted thoracic surgery with intraoperative methylene blue infusion. It is often difficult to detect ectopic mediastinal parathyroid tumor during the operation because the tumor is soft, small and buried under mediastinal tissue. After methylene blue 4 mg/kg intravenously administration, the tumor was gradually dyed blue and easily detected and resected by video-assisted thoracic surgery. It is useful of methylene blue for detection of ectopic mediastinal parathyroid tumor.
Subject(s)
Adenoma/surgery , Choristoma/surgery , Choristoma/therapy , Mediastinal Neoplasms/surgery , Methylene Blue/economics , Parathyroid Neoplasms/surgery , Thoracic Surgery, Video-Assisted , Aged , Female , HumansABSTRACT
Isosulfan blue dye has been used with increasing frequency in localizing sentinel lymph nodes in breast cancer patients. Few alternative types of dye have been investigated. In a prospective study of 30 patients, methylene blue dye was used instead of isosulfan blue dye to localize the sentinel lymph node. The methylene blue dye localization technique was successful in 90% of patients. These results are similar to those for isosulfan blue dye. This study describes methylene blue dye localization as a successful alternative to isosulfan dye in identifying the sentinel node in breast cancer patients. The methylene blue dye technique offers a substantial cost reduction.
