Intradiscal Methylene Blue Injections: Everything You Need to Know

Discography, discogram

What are intradiscal methylene blue injections?

Intradiscal methylene blue injections are often used as a diagnostic tool to identify the specific discs in the spine that are causing chronic low back pain. However, there is some evidence to suggest that the injections may have a therapeutic effect as well.

The methylene blue dye has been shown to have anti-inflammatory properties, which may help to reduce pain and improve function in some patients with chronic low back pain. The injections are typically performed by a pain management specialist or other qualified healthcare professional, and involve injecting methylene blue dye into the nucleus pulposus, the gel-like substance in the center of the intervertebral disc

What is methylene blue?

Methylene blue is a synthetic compound with a long history of use in medicine. It is commonly used as a dye in various medical procedures and as a treatment for methemoglobinemia, a condition in which the blood is unable to carry oxygen effectively.

Methylene blue has also been shown to have anti-inflammatory properties, although the mechanisms by which it exerts this effect are not yet fully understood. Inflammation is a normal response of the body’s immune system to injury or infection, but when it becomes chronic, it can contribute to a wide range of diseases and chronic pain.

Which conditions are treated with intradiscal methylene blue injections?

Intradiscal methylene blue injections are typically used to treat conditions that cause discogenic back pain, which is pain that originates from the spinal discs. Some conditions that may be treated with intradiscal methylene blue injections include:

  • Degenerative Disc Disease: This is a condition in which the spinal discs degenerate over time, leading to pain and decreased mobility.
  • Disc Herniation: This occurs when the soft inner material of the disc pushes through a tear in the outer layer, irritating nearby nerves and causing pain.

What can I expect during the procedure?

Intradiscal methylene blue injections are typically performed on an outpatient basis, either in a hospital or a specialized pain management clinic.

Here’s what you can expect during the procedure:

  1. Preparation: Before the procedure, you will be asked to change into a hospital gown and lie on your stomach on a table. You may be given a mild sedative or pain medication to help you relax and reduce any discomfort during the procedure.
  2. Local anesthesia: You will be given a local anesthetic to numb the skin and underlying tissues over the injection site.
  3. Injection: Using a needle and fluoroscopy (real-time X-ray), your doctor will insert the needle through the skin and into the intervertebral disc space. Once the needle is in place, methylene blue dye will be slowly injected into the disc.
  4. Monitoring: After the injection, you will be monitored for a short period of time to ensure that you do not experience any adverse reactions to the injection.

The procedure usually takes about 30 minutes to an hour to complete, and patients can usually go home the same day.

Are intradiscal methylene blue injections painful?

While you may still feel some pressure or discomfort during the injection, the local anesthesia should significantly reduce any pain. After the procedure, you may experience some mild pain or soreness at the injection site for a few days, but this can usually be managed with over-the-counter pain medications.

What is the recovery time after the procedure?

Most patients are able to resume their normal activities within a few days following the procedure.

However, Patients may experience some soreness or stiffness at the injection site for a few days following the procedure. To help manage these symptoms, patients may be advised to apply ice to the injection site for short periods of time or take over-the-counter pain medications as directed by their healthcare provider.

How long do they take to work?

The length of time it takes for an intradiscal methylene blue injection to take effect can vary depending on the individual and the specific spinal condition being treated.

In some cases, patients may experience immediate pain relief, while in others, it may take a few days or weeks to feel the full effects of the injection.

What are the risks of intradiscal methylene blue injections?

As with any medical procedure, intradiscal methylene blue injections do carry some risks. Here are some of the potential risks associated with this procedure:

  • Infection: Anytime the skin is punctured, there is a risk of infection. Your doctor will take steps to minimize this risk, such as using sterile equipment and administering antibiotics as necessary.
  • Bleeding: In rare cases, the needle used for the injection can puncture a blood vessel, leading to bleeding in the spinal area.
  • Nerve damage: There is a risk that the needle used for the injection can damage nearby nerves, which can cause temporary or permanent nerve damage.
  • Allergic reaction: Some people may be allergic to methylene blue dye, which can cause an allergic reaction.

Do intradiscal methylene blue injections actually work?

Intradiscal methylene blue injections have been shown to be effective in treating discogenic pain in some studies. A 2010 study by Peng et al. demonstrated a 92% satisfaction rate among patients who received an intradiscal methylene blue injection.

However, research is limited and the North American Spine Society (NASS) has concluded that there is insufficient evidence to make a recommendation for or against the use of intradiscal methylene blue injections in patients with discogenic low back pain.

Are intradiscal methylene blue injections right for me?

Intradiscal methylene blue injections may be recommended if you have been diagnosed with discogenic pain and have not found relief from other treatments such as medication or physical therapy. Your doctor may also consider this procedure if other imaging tests have failed to identify the source of your pain.

However, it’s important to keep in mind that intradiscal methylene blue injections are not appropriate for everyone, and there are risks associated with this procedure. You should discuss the potential benefits and risks with your doctor to determine if this treatment option is right for you.


Peng, Baogan et al. “A randomized placebo-controlled trial of intradiscal methylene blue injection for the treatment of chronic discogenic low back pain.” Pain vol. 149,1 (2010): 124-129. doi:10.1016/j.pain.2010.01.021

About the Author

Dave Harrison, MD

Dr. Harrison is a board certified Emergency Physician with a part time appointment at San Francisco General Medical Center and is an Assistant Clinical Professor-Volunteer at the UCSF School of Medicine. Dr. Harrison attended medical school at Tufts University and completed his Emergency Medicine residency at the University of Southern California. Dr. Harrison manages the editorial process for