GAINESVILLE, Fla. – Patients diagnosed with fibromyalgia complain of chronic pain throughout their bodies, but often doctors have difficulty detecting what causes the pain, and therefore, how to treat it.
These patients also complain of hyperalgesia, or increased sensitivity to pain. A University of Florida study
published in the July issue of the European Journal of Pain
has found that injections of the painkiller lidocaine in peripheral tissues such as muscles in the shoulders or buttocks reduced hyperalgesia, bringing researchers one step closer to understanding how chronic pain works within these patients.
“We hypothesized that if pain comes from the peripheral tissues, and we can take this pain away by injecting local anesthetics, then this would be indirect proof of the importance of peripheral tissues for the clinical pain of these individuals,” said Dr. Roland Staud, a professor of medicine within the UF College of Medicine’s department of medicine.
Sixty-two women diagnosed with fibromyalgia were involved in the study. Each woman received two injections in the trapezius muscles of the shoulders and the gluteal muscles of the buttocks, for a total of four injections per patient. The women were divided into several groups and given mechanical and heat pain stimuli immediately before and then 30 minutes after the injections. One group received four saline injections. The second group received four lidocaine injections.
Although the lidocaine injections significantly reduced hyperalgesia, the placebo injections did not. The study also found that the lidocaine and saline placebo injections both resulted in a 38 percent reduction in patients’ clinical pain, or the pain a person feels at the point of injury as well as pain radiating throughout the area near the injury. There was no statistical difference between the painkiller and the saline placebo.
Treatment of chronic pain is difficult because doctors often can’t detect evidence of injury at the site where patients experience pain, Staud said. But chronic pain affects the body differently than, for example, a single incident such as a leg break. It actually changes nerve function along patients’ spinal cords, said Michael Robinson, director of the UF Center for Pain Research and Behavioral Health.
He said hyperalgesia is a phenomenon in which the nervous system becomes sensitized to stimulation, amplifying the intensity perceived by the patient. Knowing what kind of treatment is successful in treating this sensitivity could bring researchers closer to providing relief to patients — combating their hyperalgesia and curbing chronic pain.
“The best way to treat chronic pain conditions is multidisciplinary and multimodal, looking at emotional, sensory and tissue damage. We know there are central and peripheral and social and behavioral components to someone saying, ‘Ow, it hurts,’” said Robinson, also a professor in the department of clinical and health psychology in the UF College of Public Health and Health Professions.
For example, in a person with a history of cancer pain, even if the cancer has been treated and is in remission, experiencing new pain in the afflicted area can trigger associations with the pain surrounding the patient’s cancer, including fears about the patient’s prognosis and anxiety about treatment.
“That sensation may well feel more painful than if they just thought it was a tweaked a muscle,” Robinson said.
Staud said the study can help them develop better ways of managing chronic pain.
“Over-the-counter medications and prescriptions such as opiates aren’t really effective for controlling chronic pain conditions,” Staud said. “We are able to explain the pain of chronic patients better and manage it better. We are making progress but it will take time.”
University of Florida news release, July 31, 2014.
Analgesic and anti-hyperalgesic effects of muscle injections with lidocaine or saline in patients with fibromyalgia syndrome
By Roland Staud, et al.
Source: European Journal of Pain
Background: Patients with musculoskeletal pain syndrome including fibromyalgia (FM) complain of chronic pain from deep tissues including muscles. Previous research suggests the relevance of impulse input from deep tissues for clinical FM pain. We hypothesized that blocking abnormal impulse input with intramuscular lidocaine would decrease primary and secondary hyperalgesia and FM patients' clinical pain.
Methods: We enrolled 62 female patients with FM into a double-blind controlled study of three groups who received 100 or 200?mg of lidocaine or saline injections into both trapezius and gluteal muscles. Study variables included pressure and heat hyperalgesia as well as clinical pain. In addition, placebo factors like patients' anxiety and expectation for pain relief were used as predictors of analgesia.
Results: Primary mechanical hyperalgesia at the shoulders and buttocks decreased significantly more after lidocaine than saline injections (p?=?0.004). Similar results were obtained for secondary heat hyperalgesia at the arms (p? =?0.04). After muscle injections, clinical FM pain significantly declined by 38% but was not statistically different between lidocaine and saline conditions. Placebo-related analgesic factors (e.g., patients' expectations of pain relief) accounted for 19.9% of the variance of clinical pain after the injections. Injection-related anxiety did not significantly contribute to patient analgesia.
Conclusion: These results suggest that muscle injections can reliably reduce clinical FM pain, and that peripheral impulse input is required for the maintenance of mechanical and heat hyperalgesia of patients with FM. Whereas the effects of muscle injections on hyperalgesia were greater for lidocaine than saline, the effects on clinical pain were similar for both injectates.
, July 2014. By R. Staud, E.E. Weyl, E. Bartley, D.D. Price and M.E. Robinson. Department of Medicine, University of Florida, Gainesville, USA.