Published: 2012
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Mesotherapy is a minimally invasive technique that involves injecting small amounts of medication, vitamins, minerals, and other nutrients directly into the skin to target specific areas. It has been found to be effective in managing various types of pain, including musculoskeletal pain, neuropathic pain, and even migraines.
Studies have shown that mesotherapy can provide long-lasting pain relief without the need for surgery or long-term medication use. It is a safe and cost-effective alternative for patients who have not responded to traditional pain management therapies.
Research is ongoing to further understand the mechanisms behind mesotherapy and its potential applications in pain management. This non-invasive treatment option shows promising results and continues to gain popularity among healthcare providers and patients alike.
Enhanced Treatment Benefits
Mesotherapy is a technique that involves injecting active substances into the skin for a more targeted pharmacological effect. This method allows for better control over the distribution of substances, resulting in longer-lasting effects with lower systemic exposure. Prior to mesotherapy, it is essential to conduct a thorough clinical assessment and diagnosis. Positive outcomes have been observed in studies focusing on musculoskeletal pain.
In addition to treating musculoskeletal pain, mesotherapy has also been found to be effective in improving skin quality and reducing cellulite. The technique can target specific areas of concern, such as the face, neck, and body, in order to achieve desired results. Mesotherapy treatments are relatively quick and require minimal downtime, making them a convenient option for those with busy schedules.
Optimizing Drug Delivery
By administering active ingredients close to the skin surface, mesotherapy can influence drug absorption rates and extend the duration of local effects without causing high systemic levels. For individuals who do not respond to conventional treatments, injecting substances directly into the affected area may offer therapeutic benefits. Proficiency in clinical and pharmacological techniques is crucial for the success of mesotherapy.
Instances of adverse effects have been documented due to poor sanitation practices and untrained personnel. The absence of randomized trials has cast doubts on the credibility of mesotherapy. This review critically evaluates the effectiveness and safety of mesotherapy for managing musculoskeletal pain.
It is important to note that mesotherapy is a minimally invasive procedure that involves injecting small amounts of customized medications, vitamins, and antioxidants into the mesoderm (middle layer of the skin). This targeted delivery allows for higher concentrations of active ingredients to be delivered to specific areas, resulting in improved efficacy and minimal systemic side effects.
Proponents of mesotherapy argue that it can effectively treat a variety of conditions, including cellulite, hair loss, and chronic pain. However, critics raise concerns about the lack of standardized protocols, potential for infection, and limited scientific evidence supporting its effectiveness.
Understanding Chronic Pain
Pain is a distressing sensation that arises from tissue damage and has the potential to evolve into chronic pain. Chronic pain persists over time and can be either nociceptive or neuropathic in nature. Addressing chronic pain presents challenges due to the diverse underlying causes and treatment options available, ranging from conventional NSAIDs to alternative therapies like mesotherapy, which serves as a viable alternative to NSAIDs.
In mesotherapy, small amounts of active substances are injected into the dermal layer using fine needles to achieve higher concentrations in the target tissues. Compared to intramuscular injections, this method leads to increased drug levels in the skin, muscles, and joints, resulting in prolonged benefits.
Comparison of Drug Levels
Comparison of tissue levels of Na-ketoprofen (μg) after local intradermal (LIT) versus intramuscular (IM) administration, findings adapted from [23] with permission.
| Time (hours) | Skin | Muscles | Joint tissues | |||
|---|---|---|---|---|---|---|
| Literature | Importance | Literature | Importance | Literature | Importance | |
nd = undetectable; t = trace.
Research was conducted to confirm that the introduction of LIT provides a weakened concentration of drugs in local tissues. The study aimed to compare the immunogenic properties of tetanus toxoid after intradermal and intramuscular administration. This preliminary study showed that after intradermal administration, a greater detection of immunological responses (primary and secondary) was observed. The authors suggest that the unique ability of the dermis to respond to external stimuli combined with increased antigen distribution in the vaccination area may explain these results and demonstrate new ways of using intradermal vaccine administration to reduce antigen concentration (dose savings) and the possibility of reducing the need for adjuvants (drug savings) [27].
A recent study reported that the administration of recombinant human follicle-stimulating hormone (rhFSH), injected into the skin of the abdomen at a depth of 1-2 mm instead of subcutaneous injection (10-13 mm), prolonged FSH absorption. These data confirm numerous potential clinical benefits of intradermal administration – dose reduction, decreased number of injections required to maintain elevated levels of FSH, and reduced risk of complications [28]. The superficial skin layer acts as a kind of innate “slow release system” (which will be demonstrated in other preliminary and clinical studies), and it is interesting to note that the term “local intrapidermal therapy” is used to highlight the fact that it modulates drug absorption and diffusion at the local level, even though studies have not yet been conducted using the microdialysis method.
However, the pharmacological effects of intradermal administration do not completely describe the observed clinical benefits of mesotherapy. It is believed that “microdoses” of active substances cause mechanical stretching of surrounding tissues and sensitive fibers. The needle puncture activates skin and subcutaneous receptors (reflex effect), and it is believed that the level of endorphins actually increases after needle insertion, but this hypothesis has not been confirmed. Moreover, interactions between the microvascular system and immune cells in the dermis may play a role in clinical benefits [29, 30]. Finally, it can be argued that the clinical benefits described by patients receiving parenteral analgesics may be the result of a number of “mesodermal phenomena” commonly referred to as mesotherapy.
3. Clinical Trials of Mesotherapy in Musculoskeletal Pain
The first series of open studies conducted on patients with musculoskeletal pain syndromes – including arthritis, neck, lower back pain, and tendinopathy – showed promising results in reducing pain by at least 50% compared to baseline. Positive results in pain reduction and full recovery were also presented in clinical studies among professional and amateur athletes with post-traumatic pain. Randomized and controlled studies have described clinical benefits for patients with lower back pain, cervicobrachialgia, and calcifying tendinitis of the shoulder. Confirming previously reported by other authors, demonstrating pain relief and reduction of calcifications. Interestingly, the best results were obtained when mesotherapy was combined with other types of therapy, such as transcutaneous electrical nerve stimulation (TENS) and laser or dynamic therapy. Preliminary positive data have also been obtained for painful or dental conditions.
Table 2.
Initial open studies in patients with musculoskeletal pain syndromes.
Research Studies on Musculoskeletal Disorders and Pain Management
– Ruggeri et al. 1981 [31]
– Disease: Various musculoskeletal disorders
– No. of patients: 984
– Study characteristics: M R
– Drugs utilized: NSAIDs, myorelaxants, procaine
– Control: NC
– Period of follow-up: 3-6 weeks
– No. of sessions: 1-3 sessions at 1-2 week intervals
– Outcomes: 80% of patients reported pain reduction
– Colombo et al. 1981 [32]
– Disease: Acute musculoskeletal conditions
– No. of patients: 484
– Study characteristics: M P O
– Drugs utilized: Vasodilators, NSAIDs, myorelaxants, procaine
– Control: NC
– Period of follow-up: 9 days
– No. of sessions: 3 sessions at 3-day intervals
– Outcomes: 83.6% of patients experienced pain reduction
– Saraceni et al. 1981 [33]
– Disease: Joint and tendon disorders
– No. of patients: 200
– Study characteristics: M P O
– Drugs utilized: NSAIDs, myorelaxants, vasodilator, anesthetic
– Control: NC
– Three 21-day treatment sessions
– Outcomes: 91% of patients reported pain reduction
And so on…
The table displays clinical studies or case reports evaluating pain reduction in various clinical conditions. Pain was assessed using visual scales.
M: multicentric, R: retrospective, P: prospective, O: open-label, C: controlled, NC: non-controlled, CS: case series, and ND: no data provided.
Table 3.
Clinical studies were conducted on athletes, both professionals and amateurs, with post-traumatic pain.
| Research | Disease | Number of patients | Characteristics of the study | Drugs used | Control | Observation period | Number of sessions | Outcome |
|---|
The table presents clinical studies evaluating pain reduction in various clinical conditions. Pain was assessed using visual scales.
R: retrospective, P: prospective, O: open and NC: non-controlled.
Table 4.
Randomized, controlled clinical trials in patients with low back pain, cervicobrachialgia, and calcific painful shoulder tendonitis.
The table displays clinical studies or case reports evaluating pain reduction in various clinical conditions. Pain was assessed using visual scales.
P: prospective, O: open, DB: double blind, RA: randomized, C: controlled, and PC: placebo controlled.
4. Adverse Events and Local Reactions to Mesotherapy
Evidence indicates that mesotherapy is well tolerated, though there have been reports of some adverse reactions. Mild discomfort may arise during injection, particularly in sensitive individuals. It is recommended to use a quick, gentle needle insertion technique and slowly empty the syringe. Pain during injection can be attributed to varying pH levels of medications, which can be adjusted accordingly. Local effects such as itching, hypersensitivity, discomfort, and irritation may occur due to specific drugs. Utilizing single drugs can help reduce side effects and lower the risk of infection if proper aseptic procedures are followed.
5. Role of Skin Cytochromes
The potential impact of skin cytochromes remains a topic of debate. Cytochromes in human keratocytes may influence the availability of active compounds for transdermal delivery. Limited data exists on potential drug interactions, metabolic pathways, photosensitivity reactions, or other bioactivities. It is advisable to steer clear of mixing drugs or combining substances for intradermal injections.
6. Rationale for Analgesic Drugs Injected at Local Level
Mesotherapy has the ability to swiftly alleviate musculoskeletal pain. Studies show no significant adverse events when various agents are locally injected using mesotherapy. NSAIDs are commonly employed for pain management and exhibit effectiveness when intradermally administered. They produce analgesic effects by reducing inflammatory mediators. Myorelaxants are a rational choice for alleviating myofascial syndrome pain induced by muscle spasm and hyperactivity.
Local injection of analgesic drugs offers several advantages. By targeting the affected area directly, the drugs can provide quick relief without causing systemic side effects. This localized approach also allows for lower doses of medication to be used, reducing the risk of potential drug interactions and minimizing the risk of developing tolerance to the medication over time.
In addition, the use of mesotherapy for pain management can help avoid the need for oral medications, which may be associated with gastrointestinal side effects or liver toxicity. By delivering the analgesic agents directly to the site of pain, mesotherapy offers a targeted and efficient way to manage musculoskeletal pain.
7. Recommendations
In 2010, experts reviewed and validated the scientific rationale behind mesotherapy. They concurred that when used correctly, mesotherapy is a valuable therapeutic option for managing painful conditions. Mesotherapy should only be carried out following a medical diagnosis, and patient consent is crucial. Systematic data collection, analysis, and reporting of adverse events are imperative for assessing therapeutic outcomes. The use of untested compounds should be avoided, and all adverse events must be reported to health authorities.
The use of drug combinations is less clear as it increases the risk of pharmacological interactions. However, in some cases, the safety of two active ingredients has been noted (although data on possible interactions is lacking, changes in pH, color, and precipitation in drug mixtures have been observed). Additionally, it is essential to adhere to international hygiene standards and avoid contaminating sterile syringes and needles. Before conducting intradermal therapy or other methods, an internationally endorsed pain classification scale should be used to classify pain by type and intensity. Mesotherapy is recommended for managing musculoskeletal pain syndrome either alone or in combination with other methods, in the absence of contraindications to pharmacologically active substances. However, it is not recommended for patients with allergic reactions, coagulation disorders (hemophilia, use of anticoagulants or antiplatelets), pregnant or lactating women, as well as oncology patients undergoing chemotherapy. Given the wide range of pain mechanisms and the absence of a recognized standard treatment, a patient’s response to mesotherapy determines subsequent clinical decisions, and the number of sessions depends on the severity of the pain. When treating chronic pain conditions, three phases are typically identified. The first phase (attack) focuses on pain reduction, the second phase aims to confirm results and improve the effectiveness-to-tolerability ratio, and the subsequent phase is centered around preventing recurrences. Clinical practice offers an example algorithm for managing patients who may benefit from local treatment instead of a systemic approach or combination therapy. Each physician utilizing mesotherapy for pain relief must evaluate pain before and during treatment. Therefore, it is recommended to use validated pain assessment scales and consider prolonging mesotherapy only if the patient reports at least a 50% relief compared to the baseline state.
Figure 1.
An example algorithm for the use of NSAIDs and myorelaxants with mesotherapy (intradermal therapy – IDT) for musculoskeletal pain.
In conclusion, mesotherapy has shown to be a beneficial approach in treating various forms of musculoskeletal pain. While there is still limited data from randomized controlled trials, the overall results indicate clinical benefits and good tolerance of this technique. Mesotherapy allows for gradual drug diffusion into tissues at the injection site, providing prolonged action with low doses. The microinjections aid in restoring the nociceptive system through various local actions, contributing to pain relief reported by patients. Further research and standardized treatment algorithms are needed to fully understand and optimize the use of mesotherapy in pain management.
Additional sources:
– Mason L, Moore RA, Edwards JE, Derry S, McQuay HJ. Topical NSAIDs for chronic musculoskeletal pain: systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2004;5, article 28
– Atiyeh BS, Ibrahim AE, Dibo SA. Cosmetic mesotherapy: between scientific evidence, science fiction, and lucrative business. Aesthetic Plastic Surgery. 2008;32(6):842–849
– Rotunda AM. Injectable treatments for adipose tissue: terminology, mechanism, and tissue interaction. Lasers in Surgery and Medicine. 2009;41(10)
– Koivisto VA, Felig P. Alterations in insulin absorption and in blood glucose control associated with varying insulin injection sites in diabetic patients. Annals of Internal Medicine. 1980;92(1)