Efficacy of lidocaine versus mepivacaine in the management of myofascial pain

Hamad Albagieh, Ashwag Aloyouny, Nojoud Alshehri, Noor Alsammahi, Dima Almutrafi, Emad Hadlaq, Hamad Albagieh, Ashwag Aloyouny, Nojoud Alshehri, Noor Alsammahi, Dima Almutrafi, Emad Hadlaq

Abstract

Objectives: There are many treatment modalities for myofascial pain, and recent findings reported in the literature highlight the superiority of using local anesthetics as the treatment of choice. The objective of the present study was to compare the effectiveness of two of the most used local anesthetic agents-lidocaine and mepivacaine-in the management of myofascial pain.

Materials and methods: Thirty patients (20 females, 10 males) were randomly assigned to one of two groups: 50% received lidocaine and 50% received mepivacaine. Trigger point injections in the orofacial region were administered 4 times, 10 days between each injection, with 4 weeks of follow-up after the end of the treatment course. Pain levels were recorded using a visual analog scale (VAS) at the time of follow-up and 30 min after injection.

Results: All patients exhibited statistically significant improvement when comparing pre- and post-treatment mean values. Both local anesthetics (i.e., lidocaine and mepivacaine) were similarly effective for the management of myofascial pain (p = 0.875). The mepivacaine-treated group exhibited significantly lower post-injection tenderness than the lidocaine group (p = 0.038). There was no relationship between sex and treatment response. Female and male patients both reported similar responses in terms of VAS scores (p = 0.818).

Conclusion: No drug was superior in the long term; thus, the clinician's choice can be based on drug availability and patient medical history.

Keywords: Lidocaine; MFP, myofascial pain; MTrPs, myofascial trigger points; Mepivacaine; Myofascial pain; Randomized controlled trial; SPSS, Statistical Package for the Social Sciences; Trigger points; VAS, visual analog scale.

© 2020 The Authors.

Figures

Line Graph. 1
Line Graph. 1
Y-axis: pain level on the Visual Analogue Scale (VAS) score of 0 indicated no pain and a score of 10 indicated the most severe pain. X-axis: subjects numbered from 1 to 30. It illustrates a significant pain reduction between the pre-treatment (blue line) and the post-treatment (orange line).

References

    1. Shah J.P., Gilliams E.A. Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to Myofascial Pain syndrome. J. Bodywork Movement Therap. 2008;12(4):371–384.
    1. Simons D.G. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J. Electromyogr. Kinesiol. 2004;14(1):95–107.
    1. Simons D.G. Clinical and etiological update of myofascial pain from trigger points. J. Musculoskeletal Pain. 1996;4(1–2):93–122.
    1. Fleckenstein J. Discrepancy between prevalence and perceived effectiveness of treatment methods in Myofascial Pain syndrome: results of a cross-sectional, nationwide survey. BMC Musculoskeletal Disorders. 2010;11(1):32.
    1. Gerwin R. Myofascial pain syndrome: here we are, where must we go? J. Musculoskeletal Pain. 2010;18(4):329–347.
    1. Lundberg U. Psychophysiological stress responses, muscle tension, and neck and shoulder pain among supermarket cashiers. J. Occup. Health Psychol. 1999;4(3):245.
    1. Çeliker R., Atalay A., Guven Z. Health-related quality of life in patients with Myofascial Pain syndrome. Curr. Pain Headache Rep. 2010;14(5):361–366.
    1. Ay S., Evcik D. Comparison of injection methods in Myofascial Pain syndrome: a randomized controlled trial. Clin. Rheumatol. 2010;29(1):19–23.
    1. Pérez L.M.G. Deep dry needling of trigger points located in the lateral pterygoid muscle: efficacy and safety of treatment for management of myofascial pain and temporomandibular dysfunction. Medicina oral, patología oral y cirugía bucal Ed inglesa. 2015;20(3):9.
    1. Kamanli A. Comparison of Lidocaine injection, botulinum toxin injection, and dry needling to trigger points in Myofascial Pain syndrome. Rheumatol. Int. 2005;25(8):604–611.
    1. de Abreu Venancio Botulinum toxin, Lidocaine, and dry-needling injections in patients with Myofascial Pain and headaches. CRANIO®. 2009;27(1):46–53.
    1. Karadaş Ö. Lidocaine injection of pericranial myofascial trigger points in the treatment of frequent episodic tension-type headache. J Headach Pain. 2013;14(1):1–8.
    1. Lavelle E.D. Myofascial trigger points. Anesthesiology clinics. 2007;25(4):841–851.
    1. Liu L. Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: a systematic review and meta-analysis. Arch. Phys. Med. Rehabil. 2015;96(5):944–955.
    1. Frost F.A. A control, double-blind comparison of Mepivacaine injection versus saline injection for Myofascial Pain. The Lancet. 1980;315(8167):499–501.
    1. Iwama H. Water-diluted local anesthetic for trigger-point injection in chronic myofascial pain syndrome: evaluation of types of local anesthetic and concentrations in water. Reg. Anesth. Pain Med. 2001;26(4):333–336.
    1. Brockmann W.G. Mepivacaine: a closer look at its properties and current utility. General dentistry. 2014;62:70–75.
    1. Food and Drug Administration Revised February 2010. Xylocaine (Lidocaine Hcl) accessed November 2015.
    1. Food and Drug Administration Revised February 2010.Carbocaine (Mepivacaine HCl) accessed November 2015.
    1. Clauw D.J. Fibromyalgia: a clinical review. JAMA. 2014;311(15):1547–1555.
    1. Simons D.G. New views of myofascial trigger points: etiology and diagnosis. Arch. Phys. Med. Rehabil. 2008;89(1):157–159.
    1. Yagiela J.A. Mechanism of epinephrine enhancement of Lidocaine-induced skeletal muscle necrosis. J. Dent. Res. 1982;61(5):686–690.
    1. Simons, D.G., ., 1999. Travell & Simons' Myofascial Pain and dysfunction: upper half of body (Vol. 1). Lippincott Williams & Wilkins.
    1. Hong C.Z. LIDOCAINE INJECTION VERSUS DRY NEEDLING TO MYOFASCIAL TRIGGER POINT: The Importance of the Local Twitch Response. Am. J. Phys. Med. Rehabil. 1994;73(4):256–263.
    1. Hong C.Z. Considerations and recommendations regarding myofascial trigger point injection. J. Musculoskeletal Pain. 1994;2(1):29–59.
    1. Doruk Analan P., Aslan H., Tok Umay S. A comparison of the effects of lidocaine and saline injection on pain, disability, and shear-wave elastography findings in patients with myofascial trigger points. Cyprus J. Med. Sci. 2019;4(2):103–109. doi: 10.5152/cjms.2019.709.
    1. Iwama H., Ohmori S., Kaneko T., Watanabe K. Water-diluted local anesthetic for trigger-point injection in chronic myofascial pain syndrome: evaluation of types of local anesthetic and concentrations in water. Reg. Anesth. Pain. Med. 2001;26(4):333–336. doi: 10.1053/rapm.2001.24672.
    1. Shah J.P. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch. Phys. Med. Rehabil. 2008;89(1):16–23.
    1. Li Y.M. Local anesthetics inhibit substance P binding and evoked increases in intracellular Calcium sup 2+ J. Am. Soc. Anesthesiologists. 1995;82(1):166–173.
    1. AF Ekenstam, B., et al., 1957. Local anaesthetics: I. N-alkyl pyrrolidine and N-alkyl piperidine carboxylic acid amides. Acta Chem Scand, 11, pp.1183–90.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner