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Rutter-Locher Z, Norton S, Denk F, et al. A randomised controlled trial of the effect of intra-articular lidocaine on pain scores in inflammatory arthritis. Pain. 2024 Jun 17. doi: 10.1097/j.pain.0000000000003291. (Original study)
Abstract

Chronic pain in inflammatory arthritis (IA) reflects a complex interplay between active disease in a peripheral joint and central pronociceptive mechanisms. Because intra-articular lidocaine may be used to abolish joint-specific peripheral input to the central nervous system, we aimed to validate its use as a clinical tool to identify those patients with IA whose pain likely incorporates centrally mediated mechanisms. We began by investigating whether there was a placebo response of intra-articular injection in patients with IA 1:1 randomised to receive intra-articular lidocaine or control (0.9% saline). After, in a larger patient cohort not randomized to placebo vs lidocaine groups, we tested whether patients with IA could be stratified into 2 cohorts based on their response to intra-articular lidocaine according to markers of centrally mediated pain. To this end, we evaluated postlidocaine pain numerical rating scale (NRS) scores alongside baseline painDETECT, fibromyalgia criteria fulfillment, and quantitative sensory testing outcomes. Numerical rating scale scores were collected at baseline and 3-, 5-, and 10-minutes postinjection. Firstly, the placebo effect of intra-articular injection was low: compared to baseline, the mean pain NRS score 5-minutes postinjection was reduced by 3.5 points in the lidocaine group vs 1.2 points in the control group. Secondly, postlidocaine NRS scores were significantly higher in those with a high (>18) baseline painDETECT score, fibromyalgia, and low-pressure pain threshold at the trapezius (P = 0.002, P = 0.001, P = 0.005, respectively). Persistent high pain after intra-articular lidocaine injection could be used as an indicator of pronociceptive mechanisms that are centrally mediated, informing centrally targeted analgesic strategies.

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Discipline Area Score
Physician 5 / 7
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Comments from MORE raters

Physician rater

Not a randomized trial and has a small sample size. Also, the abstract is very confusing with no discernible clinical message.

Physician rater

I found this very interesting and the non-responders in the group may actually have a more centrally located issue, which would be very important to know. And treat?

Physician rater

I could rate this as a 1 rather than a 7 for Newsworthiness because it is not directly clinically useful, but I chose 7 because I think this study may have a broader significance in helping understand pain. This type of pain is not usually managed by pain specialists.

Physician rater

injecting xylocaine into inflamed joints to determine whether the associated pain is local or central failed to determine this.
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