Objective. Clinical studies of extracorporeal shock wave therapy (ESWT) provided conflicting results depending on the use of local anesthesia (LA). Design. The present study investigated whether the biological effects of ESWT differ between appli-cation with and without LA. Setting and Patients. In 20 healthy subjects, ESWT was applied to the ventral surface of forearm skin, either after topical lidocaine pretreatment or without on the corresponding contralateral side. Measures. During and after ESWT ongoing pain, axon–reflex vasodilation (laser Doppler imaging), thresholds for pinprick, and blunt pressure were recorded. Results. The results indicate that increasing ESWT energy flux density led to increasing pain (P < 0.001). LA reduced ESWT-related pain (P < 0.02) and in parallel inhibited local axon–reflex vasodila-tion (P < 0.001). In addition, LA prevented ESWT-related drop in pressure pain threshold (P < 0.001). Conclusion. This study provided evidence that ESWT dose-dependently activates and sensitizes primary afferent nociceptive C-fibers, and that both activation and sensitization were prevented if LA was applied locally. These results suggest that LA substantially alters the biological responses of ESWT.
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