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A randomized, controlled study comparing a lidocaine patch, a placebo patch, and anesthetic injection for treatment of trigger points in patients with myofascial pain syndrome: Evaluation of pain and somatic pain thresholds

A randomized, controlled study comparing a lidocaine patch, a placebo patch, and anesthetic injection for treatment of trigger points in patients with

A randomized, controlled study comparing a lidocaine patch, a placebo patch, and anesthetic injection for treatment of trigger points in patients with myofascial pain syndrome: Evaluation of pain and somatic pain thresholds   (Citations: 14)
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Background: Myofascial pain syndrome (MPS), a regional pain condition caused by trigger points in muscle or muscle fascia, produces muscle pain, tenderness, and disability. The gold standard of treatment for MPS—infiltration of trigger points with anesthetic—may provoke discomfort to the patients and require medical intervention.Objectives: This study was designed to compare the effects of a topical lidocaine patch, a placebo patch, and injection of anesthetic (infiltration) for the symptoms of MPS in terms of pain, disability, and local tissue hypersensitivity, and to determine the acceptability of the lidocaine patch to the patients.Methods: Patients were randomly allocated to receive 1 of 3 treatments: a lidocaine patch applied to the trigger point for 4 days (replacement every 12 hours; total daily dose, 350 mg), a placebo patch applied to the trigger point for 4 days (replacement every 12 hours), or infiltration of the trigger point with two 1-mL injections of 0.5% bupivacaine hydrochloride given 2 days apart. Treatment with the patches was double-blinded, whereas treatment with infiltration was single-blinded. The number of pain attacks, pain intensity at rest and on movement, and pain-related interference with daily activity, work activity, mood, and quality of life were recorded before, during, and after treatment using a visual analog scale (VAS). Pressure and electrical pain thresholds of the skin, subcutis, and muscle in the trigger point, target area, and a pain-free area were evaluated before starting therapy (day 1) and on days 5 and 9. A VAS was used to measure discomfort from therapy, and a diary was given to each patient to record requests for additional treatment (if needed) and adverse effects.Results: Sixty white patients (46 women and 14 men) 19 to 76 years of age were studied. Mean (SD) age was 46.88 (15.37) years, and mean (SD) weight was 69.58 (13.94) kg. Twenty patients were assigned to each treatment group. Subjective symptoms did not change with placebo, but decreased significantly with the lido-caine patch and infiltration (both, P < 0.001) relative to baseline. Pain thresholds did not vary with the placebo patch, but increased significantly with the lidocaine patch and infiltration (all, P < 0.001); effects at muscle trigger points and target areas were greater with infiltration. Discomfort from therapy was greater with infiltration than with the lidocaine patch. Only patients in the placebo group requested additional treatment (P < 0.001). No adverse events occurred in any group.Conclusion: Lidocaine patches were effective in, and highly acceptable to, these patients with MPS and high tissue hypersensitivity.
Journal: Clinical Therapeutics - CLIN THER , vol. 31, no. 4, pp. 705-720, 2009
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    • ...Affaitati and coworkers [43] compared the effects of the lidocaine patch, placebo patch, and infiltration of TPs in MPS and reported that all of the patients in the lidocaine patch group experienced reductions in the number of acute pain episodes; mean pain intensity at rest and on movement; and pain-related interference with daily activity, work activity, mood, and QOL...

    Reyhan Çelikeret al. Health-related Quality of Life in Patients with Myofascial Pain Syndro...

    • ...Numerous studies evaluating various agents (eg, lidocaine,bupivacaine, and botulinum toxin A) for needling therapy have demonstrated an improvement in pain outcomes [60, 61]...

    Ja Hyun Shinet al. Management of Chronic Pelvic Pain

    • ...TrP treatment by injection (see below) produces desensitization not only locally but also in the target (thresholds significantly increased in skin, subcutis, and muscle), confirming the interdependence of the sensory changes at target level and the trigger activity [7, 13]...
    • ...The authors claimed that the diffuse tissue desensitization observed is not attributable to a systemic action of the drugs delivered locally to TrPs because TrP anesthetic infiltration previously had been shown to not produce any significant change in pain thresholds in a nonpainful area in patients without fibromyalgia [13]...

    Maria Adele Giamberardinoet al. Effects of Treatment of Myofascial Trigger Points on the Pain of Fibro...

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