Terry Amaral, MD, an orthopedic surgeon at Montefiore Medical Center, in New York City, says that methylene blue injections “could be a viable option” for disk-related low back pain, but that the results need to be replicated in other trials, preferably in other parts of the world. (Dr. Bogduk, in fact, has already received approval from the Newcastle Bone and Joint Institute to conduct a methylene blue study in Australia.)

“Back pain is not just physical,” says Dr. Amaral. “There’s a big psychological component, and cultural differences may play a role. Scientifically, kill[ing] off the nerves to get rid of pain makes sense, but it has to be proved in complex patients with many different factors involved.”

Dr. Toussaint says that methylene blue may prove less effective in a broader patient population. The patients in the study were unusual in that they had only disk-related back pain, he says, and he points out that the study did not address whether methylene blue could be effective in patients who have disk-related back pain in addition to other back problems.

“I rarely see a patient with an isolated fissure in one disk and every other part of the spine looks normal. It’s usually in combination with other things,” says Dr. Toussaint, who practices at the Texas Brain and Spine Institute, in Bryan. “My real question is whether this is generalizable.”

In the wrong hands, a risky procedure
Methylene blue injections are minimally invasive (especially compared to surgery), but they do carry some risks. Although in this study Dr. Peng and his colleagues reported no complications in the patients who received methylene blue, the chemical has proven dangerous in the past.

If used incorrectly, methylene blue can be toxic. In 2009, a Florida jury awarded a woman more than $38 million in damages for injuries she suffered from methylene blue following a botched surgery to fix a herniated disk. During a follow-up procedure, a neurosurgeon improperly injected the woman’s spine with methylene blue (as a dye) to find the location of a spinal fluid leak. As a result, the woman experienced debilitating pain throughout her body, according to a report in the Miami Herald.

The same thing that makes methylene blue a credible treatment for disk problems also makes it dangerous, explains Victor Khabie, MD, the co-chief of orthopedic surgery at Northern Westchester Hospital, in Mt. Kisco, N.Y. “Methylene blue is a very corrosive substance to the spinal cord and covering,” he says. “If it leaked out to the spine [during this procedure], it could cause an issue.”

Dr. Bogduk says that methylene blue is safe—as long as it’s administered correctly. Disk injection is easy for experienced surgeons accustomed to injecting cortisone, he says, but inexperienced or careless physicians armed with methylene blue could indeed pose a hazard.

“At this stage, I do not see any drawbacks to the drug itself,” he says. “It will be doctors, not the drug, that produce drawbacks.”