SAFETY AND EFFICACY OF MESOTHERAPY IN MUSCULOSKELETAL DISORDERS: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS WITH META-ANALYSIS

OBJECTIVES: To conduct a systematic review of randomized controlled trials about the safety (number and severity of adverse events) and efficacy (pain reduction and functional improvement) of mesotherapy in musculoskeletal disorders, and to compare them with other therapeutic options, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. METHODS: A search of PubMed, Cochrane Library and Scopus database resulted in an initial total of 16,253 records. A total of 931 articles were included in the study. A final total of 7 articles, published from 1 Jan 1999 until 30 Apr 2020 were selected. Two independent reviewers selected potentially relevant studies based on the inclusion criteria for full-text reading. They evaluated the methodological quality of each study and included only studies of high methodological quality, according to the Physiotherapy Evidence Database scale. RESULTS: Seven studies were included in the metaanalysis, and visual analogue scale scores before and after mesotherapy were considered. A statistically significant reduction in visual analogue scale score in the mesotherapy group was reported in comparison with the control group in all except one of the trials. Mesotherapy was found to be a safe procedure with mild and temporary side-effects, such as nausea, fatigue, numbness, sweating, headache, ecchymosis, bleeding, pain and local reaction at the injection site. CONCLUSION: Mesotherapy proved to be more effective than systemic therapy in the treatment of local pain and functional limitations caused by a variety of musculoskeletal conditions. However, because of the heterogeneity of the analysed studies in terms of injected drugs, administration technique, associated treatments, frequency and total number of sessions, more randomized controlled trials are needed, comparing a standardized mesotherapy protocol with a systemic treatments. LAY ABSTRACT Mesotherapy is a minimally invasive technique, based on microinjections of active drugs into the surface layer of the skin in the area to be treated. The treatment implies 2 advantages: a lower dose of drug and a rapid onset with a prolonged duration of action. The aim of this review was to analyse the safety and efficacy of mesotherapy in musculoskeletal disorders comparing it with other therapeutic options. An initial search of the literature retrieved 16,253 records. Two independent reviewers selected relevant studies based on the inclusion criteria. Furthermore, 7 studies were included for meta-analysis. The injected drugs were non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, local analgesics and muscle relaxants, of different types and concentrations, alone or variously combined. Mesotherapy was performed in the painful area, via an intradermal or subcutaneous route. It resulted in a statistically significant reduction in visual analogue scale (VAS) score in comparison with the control group in all except one of the trials. Adverse events reported for mesotherapy were generally few and mild. In conclusion, mesotherapy may be effective in enabling pain relief and functional improvement in musculoskeletal disorders, allowing patients early access to rehabilitation services, such as physiotherapy and occupational therapy, in order to achieve better outcomes in terms of independence in activities of daily living.