Mesotherapy in Pain Management in Primary Care: A Narrative Review and Practice-Oriented Appraisal.

Abstract: Mesotherapy (intradermal therapy) is an injection technique involving the administration of small amounts of drugs into the superficial dermis, where micro-deposits are formed and gradually diffuse into underlying tissues. This distinctive local pharmacokinetic profile, together with potential neurobiological and microcirculatory effects related to needle microtrauma and the injected solution, may contribute to analgesic effects in localised pain conditions, particularly of musculoskeletal origin. Across European family medicine, and more broadly within international primary care systems, there is growing interest in therapeutic strategies that are effective, safe, minimally invasive and compatible with longitudinal, patient-centred care pathways. In this context, available clinical evidence, accumulated clinical experience and international consensus recommendations suggest that mesotherapy may provide potential clinical benefits in a range of localised musculoskeletal pain conditions, including acute and chronic low back pain, neck pain, knee osteoarthritis, tendinopathies, myofascial pain syndrome and post-traumatic pain. The use of low drug doses is associated with reduced systemic exposure and a predominantly local, generally mild adverse-event profile, a feature of particular relevance in elderly and polymedicated patients commonly managed in family medicine. International consensus documents support the safe and standardised use of mesotherapy in musculoskeletal medicine and recognise its role as an adjuvant technique in other medical fields. From a primary care perspective, this article examines the clinical and organisational rationale for introducing mesotherapy into family medicine care pathways, highlighting its potential role as a complementary option within a multimodal, patient-centred approach and, in selected cases, as an early local intervention for localised musculoskeletal pain. However, it should be acknowledged that the current evidence base is characterised by a limited number of high-quality, randomised controlled trials, and that the available data do not allow definitive conclusions regarding the clinical effectiveness, cost-effectiveness or system-level impact of mesotherapy across different healthcare settings. At present, the existing evidence supports hypothesis-generating interpretations, suggesting that mesotherapy may be useful and efficient in selected clinical contexts rather than conclusively established. Within these limitations, there is a reasonable likelihood that mesotherapy could be integrated into primary care pathways for specific subgroups of patients, particularly those with well-localised musculoskeletal pain, contraindications to systemic therapies, or a high risk of drug-related adverse events. Further prospective studies, adequately powered randomised controlled trials and real-world evaluations are required to better define its clinical positioning, long-term safety, cost-effectiveness and optimal models of integration within different primary care systems. This article provides a narrative review and a practice-oriented appraisal of the available evidence.