Effect of local anesthesia on atypical odontalgia--a randomized controlled trial.
The aim of the study was to evaluate the analgesic effect of lidocaine in a double-blind, controlled multi-center study on patients with atypical odontalgia (AO)--a possible orofacial neuropathic pain condition. Thirty-five consecutive AO patients (range 31-81 years) with a mean pain duration of 7.2 years (range 1-30 years) were recruited from four different orofacial pain clinics in Sweden. In a randomized cross-over design, 1.5 ml local anesthesia (20mg/ml lidocaine and 12.5 microg/ml adrenaline) or 1.5 ml saline (9 mg/ml NaCl solution) (placebo) was injected to block the painful area. The VAS pain scores showed an overall effect of time (ANOVA: P<0.001) and treatment (ANOVA: P=0.018) with a significant interaction between the factors (ANOVA: P<0.001). Overall, VAS pain relief was significantly greater at 15-120 min following the lidocaine injections compared to the placebo injections (Tukey: P<0.05). All patients demonstrated significant disturbances in somatosensory function on the painful side compared to the non-painful side as revealed by quantitative sensory tests, however, only one significant inverse correlation was found between percentage pain relief and the magnitude of brush-evoked allodynia (Spearman: P<0.01). In conclusion, AO patients experienced significant, but not complete, pain relief from administration of local anesthetics compared with placebo. The findings indicate that the spontaneous pain in AO patients only to some extent is dependent on peripheral afferent inputs and that sensitization of higher order neurons may be involved in the pathophysiology of AO.
Orofacial Pain Unit, Faculty of Odontology, Malmö University, Malmö, Sweden Division of Neurology, Department of Neuroscience and Locomotion, University Hospital, Linköping, Sweden Department of Stomatognathic Physiology, The Institute for Postgraduate Dental Education, Jönköping, Sweden Department of Stomatognathic Physiology, County Hospital, Kalmar, Sweden Department of Clinical Oral Physiology, School of Dentistry, University of Aarhus, Denmark Department of Oral Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark.
Thomas
T
List
Göran
G
Leijon
Martti
M
Helkimo
Anders
A
Öster
Peter
P
Svensson
D000328:Adult; D000344:Afferent Pathways / Q000503:physiopathology; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D013997:Time Factors; D014098:Toothache / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
D000779:Anesthetics, Local; D008012:Lidocaine