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Pain Med. 2011 Oct;12(10):1532-7. doi: 10.1111/j.1526-4637.2011.01229.x. Epub 2011 Sep 14.

Application of local anesthesia inhibits effects of low-energy extracorporeal shock wave treatment (ESWT) on nociceptors.

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  • 1Department of Trauma Surgery, University Medical Centre, Mainz, Germany.

Abstract

OBJECTIVE:

Clinical studies of extracorporeal shock wave therapy (ESWT) provided conflicting results depending on the use of local anesthesia (LA).

DESIGN:

The present study investigated whether the biological effects of ESWT differ between application with and without LA.

SETTING AND PATIENTS:

In 20 healthy subjects, ESWT was applied to the ventral surface of forearm skin, either after topical lidocaine pretreatment or without on the corresponding contralateral side.

MEASURES:

During and after ESWT ongoing pain, axon-reflex vasodilation (laser Doppler imaging), thresholds for pinprick, and blunt pressure were recorded.

RESULTS:

The results indicate that increasing ESWT energy flux density led to increasing pain (P < 0.001). LA reduced ESWT-related pain (P < 0.02) and in parallel inhibited local axon-reflex vasodilation (P < 0.001). In addition, LA prevented ESWT-related drop in pressure pain threshold (P < 0.001).

CONCLUSION:

This study provided evidence that ESWT dose-dependently activates and sensitizes primary afferent nociceptive C-fibers, and that both activation and sensitization were prevented if LA was applied locally. These results suggest that LA substantially alters the biological responses of ESWT.

Wiley Periodicals, Inc.

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