Effects of Experimental Pain and Lidocaine on Mechanical Somatosensory Profile and Face Perception

Aims: To assess the effects of experimental muscle pain and topical lidocaine applied to the skin overlying the masseter muscle on the mechanical somatosensory profile and face perception of the masseter muscle in healthy participants. Methods: A total of 28 healthy participants received a 45-minute application of a lidocaine or placebo patch to the skin overlying the masseter muscle followed by one injection of 0.2 mL sterile solution of monosodium glutamate. Measurements were taken four times during each session of quantitative sensory testing (QST) (T0 = baseline, T1 = 45 minutes after patch application, T2 = immediately after glutamate injection, and T3 = 25 minutes after the glutamate injection), and the following variables were measured: mechanical detection threshold (MDT), mechanical pain threshold (MPT), pressure pain threshold (PPT), pain report (pain on palpation, pain spreading on palpation, and pain intensity), pain drawing, and perceptual distortion. Multi-way within-subjects analysis of variance (ANOVA) was applied to the data. Results: The highest MDTs were present at T2 (F = 49.28, P < .001), the lowest PPTs were present at T2 and T3 (F = 21.78, P < .001), and the largest magnitude and area of perceptual distortion were reported at T2 (F > 6.48, P < .001). Conclusion: Short-lasting experimental muscle pain was capable of causing loss of tactile sensitivity as well as perceptual distortion of the face, regardless of preconditioning with a topical lidocaine patch. Short-term application of a lidocaine patch did not significantly affect the mechanical somatosensory profile.

local anesthesia; musculoskeletal pain; pain measurement; sensory thresholds; touch perception

1. Backonja MM, Attal N, Baron R, et al. Value of quantitative sensory testing in neurological and pain disorders: NeuPSIG consensus. Pain 2013;154:1807–1819.

2. Svensson P, Baad-Hansen L, Pigg M, et al. Guidelines and recommendations for assessment of somatosensory function in oro-facial pain conditions—a taskforce report. J Oral Rehabil 2011;38:366–394.

3. Greenspan JD, Slade GD, Bair E, et al. Pain sensitivity risk factors for chronic TMD: Descriptive data and empirically identified domains from the OPPERA case control study. J Pain 2011; 12:T61–T74.

4. Kothari SF, Baad-Hansen L, Oono Y, Svensson P. Somatosensory assessment and conditioned pain modulation in temporomandibular disorders pain patients. Pain 2015;156:2545–2555.

5. Pfau DB, Rolke R, Nickel R, Treede RD, Daublaender M. Somatosensory profiles in subgroups of patients with myogenic temporomandibular disorders and fibromyalgia syndrome. Pain 2009;147:72–83.

6. Uddin Z, MacDermid JC. Quantitative sensory testing in chronic musculoskeletal pain. Pain Med 2016;17:1694–1703.

7. Luo Y, Svensson P, Jensen JD, et al. Quantitative sensory testing in patients with or without ongoing pain one year after orthognathic surgery. J Oral Facial Pain Headache 2014;28:306–316.

8. Castrillon EE, Cairns BE, Ernberg M, et al. Glutamate-evoked jaw muscle pain as a model of persistent myofascial TMD pain? Arch Oral Biol 2008;53:666–676.

9. Neblett R, Cohen H, Choi Y, et al. The Central Sensitization Inventory (CSI): Establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample. J Pain 2013;14:438–445.

10. Svensson P. What can human experimental pain models teach us about clinical TMD? Arch Oral Biol 2007;52:391–394.

11. Üçeyler N, Zeller D, Kahn AK, et al. Small fibre pathology in patients with fibromyalgia syndrome. Brain 2013;136:1857–1867.

12. Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache 2014;28:6–27.

13. Fujisawa M, Shoji S, Ishibashi K, Clark GT. Pressure pain threshold with and without iontophoretic anesthesia of the masseter muscle in asymptomatic males. J Orofac Pain 1999;13:97–103.

14. Reid KI, Carlson C, Rayens MK, Gracely RH. The influence of cutaneous tissue afferents on masticatory pain-pressure thresholds. J Orofac Pain 1996;10:324–329.

15. Skyt I, Dagsdóttir L, Vase L, et al. Painful stimulation and transient blocking of nerve transduction due to local anesthesia evoke perceptual distortions of the face in healthy volunteers. J Pain 2015;16:335–345.

16. Dagsdóttir LK, Skyt I, Vase L, Baad-Hansen L, Castrillon E, Svensson P. Experimental orofacial pain and sensory deprivation lead to perceptual distortion of theface in healthy volunteers. Exp Brain Res 2015;233:2597–2606.

17. Svensson P, Arendt-Nielsen L, Nielsen H, Larsen JK. Effect of chronic and experimental jaw muscle pain on pain-pressure thresholds and stimulus-response curves. J Orofac Pain 1995; 9:347–356.

18. Rolke R, Baron R, Maier C, et al. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Standardized protocol and reference values. Pain 2006;123: 231–243.

19. Futarmal S, Kothari M, Ayesh E, Baad-Hansen L, Svensson P. New palpometer with implications for assessment of deep pain sensitivity. J Dent Res 2011;90:918–922.

20. Svensson P, Arendt-Nielsen L, Houe L. Muscle pain modulates mastication: An experimental study in humans. J Orofac Pain 1998;12:7–16.

21. Krumova EK, Zeller M, Westermann A, Maier C. Lidocaine patch (5%) produces a selective, but incomplete block of Aδ and C fibers. Pain 2012;153:273–280.

22. Rolke R, Magerl W, Campbell KA, et al. Quantitative sensory testing: A comprehensive protocol for clinical trials. Eur J Pain 2006;10:77–88.

23. Kauppila T, Mohammadian P, Nielsen J, Andersen OK, ArendtNielsen L. Capsaicin-induced impairment of tactile spatial discrimination ability in man: Indirect evidence for increased receptive fields in human nervous system. Brain Res 1998;797: 361–367.

24. Stohler CS, Kowalski CJ, Lund JP. Muscle pain inhibits cutaneous touch perception. Pain 2001;92:327–333.

25. Magerl W, Treede RD. Secondary tactile hypoesthesia: A novel type of pain-induced somatosensory plasticity in human subjects. Neurosci Lett 2004;361:136–139.

26. Melzack R, Wall PD. Pain mechanisms: A new theory. Science 1965;150:971–979.

27. Cruz-Almeida Y, Fillingim RB. Can quantitative sensory testing move us closer to mechanism-based pain management? Pain Med 2014;15:61–72.

28. Rossini PM, Martino G, Narici L, et al. Short-term brain ‘plasticity’ in humans: Transient finger representation changes in sensory cortex somatotopy following ischemic anesthesia. Brain Res 1994;642:169–177.

29. Sessle BJ, Hu JW, Amano N, Zhong G. Convergence of cutaneous, tooth pulp, visceral, neck and muscle afferents onto nociceptive and non-nociceptive neurones in trigeminal subnucleus caudalis (medullary dorsal horn) and its implications for referred pain. Pain 1986;27:219–235.

30. Doppler K, Rittner HL, Deckart M, Sommer C. Reduced dermal nerve fiber diameter in skin biopsies of patients with fibromyalgia. Pain 2015;156:2319–2325.

31. Butterworth JF 4th, Strichartz GR. Molecular mechanisms of local anesthesia: A review. Anesthesiology 1990;72:711–734.

32. Eidelman A, Weiss JM, Lau J, Carr DB. Topical anesthetics for dermal instrumentation: A systematic review of randomized, controlled trials. Ann Emerg Med 2005;46:343–351.

33. List T, Mojir K, Svensson P, Pigg M. A new protocol to evaluate the effect of topical anesthesia. Anesth Prog 2014;61:135–144.

34. Gupta AK, Sibbald RG. Eutectic lidocaine/prilocaine 5%cream and patch may provide satisfactory analgesia for excisional biopsy or curettage with electrosurgery of cutaneous lesions. A randomized, controlled, parallel group study. J Am Acad Dermatol 1996;35:419–423.

35. Lam VY, Wallace M, Schulteis G. Effects of lidocaine patch on intradermal capsaicin-induced pain: A double-blind, controlled trial. J Pain 2011;12:323–330.

36. Gokin AP, Philip B, Strichartz GR. Preferential block of small myelinated sensory and motor fibers by lidocaine: In vivo electrophysiology in the rat sciatic nerve. Anesthesiology 2001;95:1441–1454.

37. Jaffe RA, Rowe MA. Differential nerve block. Direct measurements on individual myelinated and unmyelinated dorsal root axons. Anesthesiology 1996;84:1455–1464.

38. Munger BL, Halata Z. The sensory innervation of primate facial skin. I. Hairy skin. Brain Res 1983;286:45–80.

39. Mouraux A, Iannetti GD, Plaghki L. Low intensity intra-epidermal electrical stimulation can activate Aδ-nociceptors selectively. Pain 2010;150:199–207.

40. Komiyama O, De Laat A. Tactile and pain thresholds in the intra- and extra-oral regions of symptom-free subjects. Pain 2005;115:308–315.

41. Herberger K, Krause K, Maier K, Zschocke I, Radtke M, Augustin M. Local anesthetic effects of Lidocaine cream: Randomized controlled trial using a standardized prick pain. J Dermatolog Treat 2012;23:437–442.

42. Derry S, Wiffen PJ, Moore RA, Quinlan J. Topical lidocaine for neuropathic pain in adults. Cochrane Database Syst Rev 2014;(7):CD010958.