Comparing the Effect of Subcutaneous and Intradermal Mesotherapy on Pain and Function in Knee Osteoarthritis: A Randomized Clinical Trial

Abstract

Background: Knee osteoarthritis (KOA) is the most common form of osteoarthritis and is associated with pain and functional impairment. Mesotherapy, which involves localized intradermal or subcutaneous injection of active agents, may provide targeted pain relief. This study aimed to compare the effects of intradermal and subcutaneous mesotherapy on pain and function in patients with KOA. Materials and Methods: A single-center, randomized, assessor-blinded clinical trial was conducted in Isfahan, Iran, between 2023 and 2024 among patients with mild-to-moderate KOA. Each patient received six sessions of intradermal or subcutaneous piroxicam-lidocaine mesotherapy at six acupuncture points over three weeks (two sessions per week). Pain and function were assessed at baseline, immediately after treatment, and one month after treatment. Statistical analyses included chi-square tests for qualitative variables, independent-samples t-tests for quantitative variables, and repeated-measures analysis of variance to assess changes over time. Statistical significance was set at P<0.05. Results: A total of 50 patients were included. The demographic characteristics and baseline pain and function scores did not differ significantly between the two groups. At the one-month follow-up, the intradermal group showed significantly greater improvement, with a mean difference in pain score reduction of 1.6 points (95 CI: 0.57 to 2.67, P=0.003) compared to the subcutaneous group. For dysfunction scores, the intradermal group demonstrated immediate post-treatment benefits (mean difference: 9.4 points, 95 CI: 1.36 to 17.44, P=0.02), with sustained improvement at changed over time in both groups (P<0.001). Conclusion: Both subcutaneous and intradermal mesotherapy appeared to be effective short-term treatments for patients with KOA. However, intradermal mesotherapy demonstrated greater effectiveness at the one-month follow-up, with superior pain reduction and functional improvement compared with subcutaneous mesotherapy.