psd-502 and Ehlers-Danlos-Syndrome

To make a differential diagnosis of Ehlers Danlos (EDS) Type III syndrome and Hypermobile patients has been difficult. In genetic advising and prognosis of the EDS patients there are need for new tools to separate them from hypermobile patients. Topical analgesics (EMLA cream) was applied to seven EDS patients, ten hypermobile patients, and to fifteen controls. The analgesic efficacy of cutaneous analgesia was evaluated by sensory and pain thresholds to brief argon laser stimuli, and the depth of the cutaneous analgesia was measured by sensory and pain threshold depth to controlled needle insertions. Controls and hypermobiles did not differ in their response to cutaneous analgesia. The thresholds to cutaneous laser stimulation and the depth of analgesia increased significantly less in the Ehlers Danlos patients compared to the other two groups. In clinical practice a needle insertion test can easily be applied to investigate if patients are responders or non-responders to local analgesics.

Topics: Adult; Anesthetics, Local; Diagnosis, Differential; Drug Combinations; Ehlers-Danlos Syndrome; Female; Humans; Joint Instability; Lasers; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Needles; Pain Measurement; Prilocaine; Sensory Thresholds

The analgesic effects of intradermal lidocaine infiltration and topical EMLA cream applications (eutectic mixture of local anaesthetics) were studied in 8 patients with Ehlers Danlos syndrome type III, a heritable disorder of connective tissue, and in 8 controls. Cutaneous analgesia was evaluated by sensory and pain thresholds to short argon laser stimulation, and the depth of cutaneous analgesia was measured by sensory and pain thresholds to controlled needle insertion. Five minutes after lidocaine infiltration, the laser-induced pain was abolished in both groups, but 1 h later only the skin of the controls remained analgesic. EMLA cream was applied for 30, 60, and 120 min, but none of the patients obtained sufficient analgesia. Full analgesia was obtained for the controls after 60 and 120 min of application. The depth of cutaneous EMLA analgesia was significantly less for the patients compared to controls. The present quantitative findings support clinical observations that long-lasting cutaneous analgesia is difficult to obtain for this group of patients.

Topics: Adult; Anesthetics, Local; Drug Combinations; Ehlers-Danlos Syndrome; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Prilocaine