Skip to main content
Erschienen in: Pain and Therapy 1/2016

Open Access 26.05.2016 | Commentary

Should the General Practitioner Consider Mesotherapy (Intradermal Therapy) to Manage Localized Pain?

verfasst von: Massimo Mammucari, Enrica Maggiori, Marzia Lazzari, Silvia Natoli

Erschienen in: Pain and Therapy | Ausgabe 1/2016

download
DOWNLOAD
print
DRUCKEN
insite
SUCHEN

Abstract

Wide variations in the types of pain and response to analgesic pharmacotherapy mean that a variety of treatment strategies are needed. One approach is mesotherapy (intradermal therapy). This consists of microinjections into the skin and is ideally suited to the management of localized pain. Advantages include increasing the duration of drug activity, reduced risk of adverse events and interactions, and possible synergy with other therapies. Mesotherapy provides general practitioners with another tool for the treatment of local pain. However, it is important to provide patients with full details of the pros and cons of this approach and obtain informed patient consent.
Hinweise

Enhanced content

To view enhanced content for this article go to http://​www.​medengine.​com/​Redeem/​42D4F0601A0E1F98​.

Commentary

There is heterogeneity between different types of pain due to different pathophysiological mechanisms and response to analgesics [1, 2]. General practitioners (GPs) often detect persistent localized pain in patients with several coexisting disorders and who are at high risk of adverse events. In these circumstances, or when the use of pain medication is contraindicated or cannot be prescribed for long periods due to safety reasons, the GP needs alternative therapeutic strategies to control pain.
Mesotherapy (intradermal therapy) can be included as an additional treatment approach for the management of localized pain. It consists of a series of micro-injections in the upper layers of the skin. This allows a slow diffusion of the drug compared with deep-administration [3]. The micro-injections are performed using a syringe with a 4-mm (27 gauge) needle or 13-mm (30 or 32 gauge) needle, usually inserted at an angle of about 30°–45° with respect to the skin’s surface. This technique has several advantages, including modulation of drug kinetics with prolonged local pharmacological activity, drug-sparing effects, a reduction in the risk of systemic interaction, and potential synergy with other therapies [3]. Mesotherapy is applied for some types of localized musculoskeletal pain and clinical benefits have been shown with lower doses of nonsteroidal anti-inflammatory drug (NSAIDs), muscle relaxants, anesthetics, and other analgesics. In fact, in a recent review [4] it was observed that a series of open studies involving a total of 2422 patients with various types of pain (cervical pain, back pain, tendinitis) highlighted a reduction in pain of at least 50% from baseline. In addition to the reduction of post-traumatic pain (778 professional athletes observed), a rapid functional recovery was achieved after a mesotherapy treatment.
The intradermal route of drug administration has become an alternative to the intramuscular route and is also being used for the administration of vaccines due to a greater immune response having been obtained with a lower dose of antigen compared to the intramuscular administration [5]. To practice this technique the following are required: clinical and pharmacological skills; ability to select patients to be treated; and communication skills to obtain valid informed consent. [6]. Over the years, in many countries there has been a growing interest in mesotherapy, especially in the field of esthetic medicine, both to correct skin disorders and to prevent the aging of the skin. The strong appeal of cosmetic applications for mesotherapy has resulted in use by non-medical personnel with a variety of off-label medications. Lack of compliance with minimum aseptic requirements during cosmetic uses has contributed to some adverse outcomes [7, 8]. Fortunately, recommendations for proper medical use of this technique have been suggested, particularly to manage patients with minor localized pain syndrome [3, 4, 9]. In our primary care setting, after querying a database containing 2503 patients treated in the last 10 years (mean age 58.52 + 12.13; age range 14–98; 58.01% female), we detected a significant percentage of patients with one or more contraindications for long-term systemic anti-inflammatory drug treatment. In addition, 33.04% of the study population (827 patients with an average age of 57 ± 1.52 years; 55.7% male) had reported one or more episodes of moderate or severe pain (of the hip, neck, back or knee) secondary to osteo-articular disease. Of those, 376 (45.5%) had a history of cardiovascular disease, heart failure, hypertension, renal impairment, diabetes mellitus, gastrointestinal disorders, or chronic obstructive pulmonary disease with asthma. A total of 14.63% of patients with recurrent episodes of localized pain (4.8% of the observed population) aged 75 years and over had a history of clinical and pharmacological conditions suggesting that local treatment with anti-inflammatory drugs would be more appropriate than systemic. Based on available data [4], we may assume that at least 50% of this subgroup of patients (elderly, under multiple treatments, and with more than one episode of recurrent pain) could benefit from a local treatment such as mesotherapy.
Although preliminary randomized controlled trials conducted to date reported clinical benefit in 332 patients with back pain, cervicobrachialgia, and calcifying tendinitis of the shoulder [1014], we suggest more well-designed randomized controlled studies to better define the clinical role of mesotherapy should be performed.
Chronic musculoskeletal pain (including low back, osteoarthritic, post-traumatic, and neuropathic pain) results from a complex interaction of mechanical and biochemical factors. Frequently, many patients with this type of localized pain cannot be treated with long-term courses of NSAIDs due to safety reasons, and in these cases, opioids are suggested. However, these drugs should be used carefully to prevent iatrogenic risk [15]. A multimodal approach to pain may help to reduce a drug’s toxicity by lowering the total dose of any single drug used to target different pain mechanisms. Under this point of view, unmanageable localized pain could benefit from a localized treatment that takes advantage of the principles of mesotherapy and may contribute to the reduction of the systemic administration of medications.

Conclusion

In conclusion, GPs should consider local analgesic strategies whenever systemic treatment increases the risk of drug reactions or interactions. In this setting, mesotherapy may be a useful ally against unnecessary pain. However, it should be underlined that any analgesic technique has strengths and weaknesses. Therefore, the patient should be involved in pain management and informed about potential risks and failures. For this reason, informed consent is both good clinical practice and helps the patient to fully understand the limits and benefits of the therapeutic strategy proposed [6].
Selecting patients and establishing a treatment plan that takes advantage of the drug-sparing effect of mesotherapy, alone or in combination with other treatments, means the patient may achieve therapeutic success. Of course nothing is fixed, and the doctor has a duty to consider carefully whether mesotherapy is or is not appropriate in every individual case.
This article does not contain any new studies with human or animal subjects performed by any of the authors.

Acknowledgments

No funding or sponsorship was received for this study or publication of this article. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. We also thank the Italian Society of Mesotherapy (http://​www.​societadimesoter​apia.​it). This article is dedicated to Sergio Maggiori and Antonio Gatti. English language editing assistance in the preparation of this manuscript was provided by Nicola Ryan, on behalf of Springer Healthcare Italy.

Disclosures

Mammucari Massimo, Maggiori Enrica, Marzia Lazzari and Silvia Natoli have nothing to disclose.

Compliance with Ethics Guidelines

This article does not contain any new studies with human or animal subjects performed by any of the authors.

Open Access

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://​creativecommons.​org/​licenses/​by-nc/​4.​0/​), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://​creativecommons.​org/​licenses/​by/​4.​0), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Literatur
1.
2.
Zurück zum Zitat Dieppe P. Chronic musculoskeletal pain. Br Med J. 2013;346:bmj.f3146.CrossRef Dieppe P. Chronic musculoskeletal pain. Br Med J. 2013;346:bmj.f3146.CrossRef
3.
Zurück zum Zitat Mammucari M, Gatti A, Maggiori S, Bartoletti CA, Sabato AF. Mesotherapy, definition, rationale and clinical role: a consensus report from the Italian Society of Mesotherapy. Eur Rev Med Pharmacol Sci. 2011;15:682–94.PubMed Mammucari M, Gatti A, Maggiori S, Bartoletti CA, Sabato AF. Mesotherapy, definition, rationale and clinical role: a consensus report from the Italian Society of Mesotherapy. Eur Rev Med Pharmacol Sci. 2011;15:682–94.PubMed
4.
Zurück zum Zitat Mammucari M, Gatti A, Maggiori S, Sabato AF. Role of mesotherapy in musculoskeletal pain: opinions from the Italian Society of Mesotherapy. Evid Based Complement Altern Med. 2012;2012:436959.CrossRef Mammucari M, Gatti A, Maggiori S, Sabato AF. Role of mesotherapy in musculoskeletal pain: opinions from the Italian Society of Mesotherapy. Evid Based Complement Altern Med. 2012;2012:436959.CrossRef
5.
Zurück zum Zitat Kenney RT, Frech SA, Muenz LR, et al. Dose sparing with intradermal injection of influenza vaccine. N Engl J Med. 2004;351:2295–301.CrossRefPubMed Kenney RT, Frech SA, Muenz LR, et al. Dose sparing with intradermal injection of influenza vaccine. N Engl J Med. 2004;351:2295–301.CrossRefPubMed
6.
Zurück zum Zitat Mammucari M, Lazzari M, Maggiori E, et al. Role of the informed consent, from mesotherapy to opioid therapy. Eur Rev Med Pharmacol Sci. 2014;18:566–74.PubMed Mammucari M, Lazzari M, Maggiori E, et al. Role of the informed consent, from mesotherapy to opioid therapy. Eur Rev Med Pharmacol Sci. 2014;18:566–74.PubMed
7.
Zurück zum Zitat Carbonne A, Brossier F, Arnaud I, et al. Outbreak of non-tuberculous mycobacterial subcutaneous infections related to multiple mesotherapy injections. J Clin Microbiol. 2009;47:1961–4.CrossRefPubMedPubMedCentral Carbonne A, Brossier F, Arnaud I, et al. Outbreak of non-tuberculous mycobacterial subcutaneous infections related to multiple mesotherapy injections. J Clin Microbiol. 2009;47:1961–4.CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Atiyeh BS, Ibrahim AE, Dibo SA. Cosmetic mesotherapy: between scientific evidence, science fiction, and lucrative business. Aesthet Plast Surg. 2008;32:842–9.CrossRef Atiyeh BS, Ibrahim AE, Dibo SA. Cosmetic mesotherapy: between scientific evidence, science fiction, and lucrative business. Aesthet Plast Surg. 2008;32:842–9.CrossRef
9.
Zurück zum Zitat Mammucari M, Vellucci R, Mediati RD, et al. What is mesotherapy? Recommendations from an international consensus. Trends Med. 2014;14:1–10. Mammucari M, Vellucci R, Mediati RD, et al. What is mesotherapy? Recommendations from an international consensus. Trends Med. 2014;14:1–10.
10.
Zurück zum Zitat Parrini M, Bergamaschi R, Azzoni R. Controlled study of acetylsalicylic acid efficacy by mesotherapy in lumbo-sciatic pain. Minerva Ortop e Traumatol. 2002;53(3):181–6. Parrini M, Bergamaschi R, Azzoni R. Controlled study of acetylsalicylic acid efficacy by mesotherapy in lumbo-sciatic pain. Minerva Ortop e Traumatol. 2002;53(3):181–6.
11.
Zurück zum Zitat Monticone M, Barbarino A, Testi C, Arzano S, Moschi A, Negrini S. Symptomatic efficacy of stabilizing treatment versus laser therapy for sub-acute low back pain with positive tests for sacroiliac dysfunction: a randomised clinical controlled trial with 1 year follow-up. Eura Medicophys. 2004;40(4):263–8.PubMed Monticone M, Barbarino A, Testi C, Arzano S, Moschi A, Negrini S. Symptomatic efficacy of stabilizing treatment versus laser therapy for sub-acute low back pain with positive tests for sacroiliac dysfunction: a randomised clinical controlled trial with 1 year follow-up. Eura Medicophys. 2004;40(4):263–8.PubMed
12.
Zurück zum Zitat Costantino C, Marangio E, Coruzzi G. Mesotherapy versus systemic therapy in the treatment of acute low back pain: a randomized trial. Evid Based Complement Altern Med. 2011;2011:317183. Costantino C, Marangio E, Coruzzi G. Mesotherapy versus systemic therapy in the treatment of acute low back pain: a randomized trial. Evid Based Complement Altern Med. 2011;2011:317183.
13.
Zurück zum Zitat Di Cesare A, Giombini A, Di Cesare M, Ripani M, Yulpiani M, Saraceni VM. Comparison between the effects of trigger point mesotherapy versus acupuncture points mesotherapy in the treatment of chronic low back pain: a short term randomized controlled trial. Complement Ther Med. 2011;19(1):19–26.CrossRefPubMed Di Cesare A, Giombini A, Di Cesare M, Ripani M, Yulpiani M, Saraceni VM. Comparison between the effects of trigger point mesotherapy versus acupuncture points mesotherapy in the treatment of chronic low back pain: a short term randomized controlled trial. Complement Ther Med. 2011;19(1):19–26.CrossRefPubMed
14.
Zurück zum Zitat Cacchio A, De Blasis E, Desiati P, Spacca G, Santilli V, De Paulis F. Effectiveness of treatment of calcific tendinitis of the shoulder by disodium EDTA. Arthritis Rheum. 2009;61(1):84–91.CrossRefPubMed Cacchio A, De Blasis E, Desiati P, Spacca G, Santilli V, De Paulis F. Effectiveness of treatment of calcific tendinitis of the shoulder by disodium EDTA. Arthritis Rheum. 2009;61(1):84–91.CrossRefPubMed
15.
Zurück zum Zitat Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016;315(15):1624–45.CrossRefPubMed Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016;315(15):1624–45.CrossRefPubMed
Metadaten
Titel
Should the General Practitioner Consider Mesotherapy (Intradermal Therapy) to Manage Localized Pain?
verfasst von
Massimo Mammucari
Enrica Maggiori
Marzia Lazzari
Silvia Natoli
Publikationsdatum
26.05.2016
Verlag
Springer Healthcare
Erschienen in
Pain and Therapy / Ausgabe 1/2016
Print ISSN: 2193-8237
Elektronische ISSN: 2193-651X
DOI
https://doi.org/10.1007/s40122-016-0052-3

Weitere Artikel der Ausgabe 1/2016

Pain and Therapy 1/2016 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.