Novocaine & CIDP

Gary,

I had posted a thread a month or so about this. I think the thread was “Dentist” under either GBS or the main forum. Rocky (I think) told me to ask for a numbing agent without vasopressors. I printed it out and gave it to my dentist and he knew what I was talking about and used a different numbing agent, that he used on an MS patient. It is not as strong and doesn’t last as long, but it is better than nothing!

You never know. I have had CIDP for 17 years with regular treatment. I also have had several root canals, crowns, filings etc. and all with shots whatever to deaden mouth and no problems. I think they use lidocain. I had lidocain several times when doing plasmaphersis and no problem. I have had four neurologists – all good – and none ever mentioned any problems with any kind of anesthetic. Also had 8 surgeries with complete anesthesia to put me to sleep and no problems. Maybe I am just lucky. Who knows?

I haven’t had a problem at the dentist but I’m not sure if he uses Novocaine or lidocain.

All:

It’s not the lidocaine, sensorcaine, marcaine, etc. that is the issue. It is the addition of epinipherine with all of those that makes the difference in CIDP.

DO NOT get “with epi”. The dentists should all know what you are talking about and be easily able to accommodate!

In my case it was because I was on an anti-seizure med at the time.
Be alert that the combo can cause serious actions/reactions. It should be outlined in that teeny, fine-print brochure you get w/your meds called drug/prescribing information. Look it up on the web? You can actually enlarge it to READ IT!
Also know that the ‘alternatives’ often take a few more minutes to kick in and also wear off faster. So make sure you and your dentist are clear on hand signals or certain sounds that you mite make to indicate distress or OW!
Hope this helps?

Hi Gary,

One side of my face is affected by CIDP.
When I had a couple of fillings done (with a short acting local anaesthetic) on the side unaffected by CIDP, I found the local wore off fine…just about as soon as the fillings were finished. But, on the side affected by CIDP after I had another couple of fillings done – (same local used), it took hours to wear off…with some unusual sensations as well. :confused:

Kazza

Jessicah,

I told you about vasopressors on the “Dentist” thread at the Adult GBS Forum. Vasopressors are compounds which cause the blood vessels to constrict. As the blood vessels constrict, blood pressure rises. A number of compounds work as vasopressors, ranging from pharmaceuticals which are used on patients in certain situations to recreational drugs which have a vasoconstrictive effect. Such compounds need to be used carefully, because they can cause blood pressure to rise dangerously high, putting someone at risk of medical complications.

Lidocaine and any other endogenous pentapeptide acting as a sodium channel blocker should not be used by CIDP, GBS, or MS patients. See weblink: [url]www.multsclerosis.org/news/Jul2000/Unmaskingsubclinicallesions.html[/url]

[SIZE=”3″][B]An endogenous pentapeptide acting as a sodium channel blocker in inflammatory autoimmune disorders of the central nervous system.[/B][/SIZE]
[url]http://www.nature.com/cgi-taf/DynaPage.taf?file=//nm/journal/v6/n7/abs/nm0700_808.html&filetype=[/url]

Nat Med 2000 Jul;6(7):808-11

Brinkmeier H, Aulkemeyer P, Wollinsky KH, Rudel R

Department of General Physiology, University of Ulm, D-89069 Ulm, Germany.

Reversible blockade of sodium channels by endogenous substances has been claimed to account for the fast exacerbations and relapses commonly seen in demyelinating autoimmune diseases. Evidence has been provided that in the cerebrospinal fluid of patients with multiple sclerosis or Guillain-Barre syndrome, a sodium-channel-blocking factor exists that has properties of local anesthetic agents. This factor could contribute to the nerve conduction block and paresis seen in these disorders. We describe here a previously unknown endogenous substance in human cerebrospinal fluid with distinct channel-blocking properties even at very low (0.00001 M) concentrations. The pentapeptide with the sequence Gln-Tyr-Asn-Ala-Asp exerted its blocking action by shifting the steady-state inactivation curve of the sodium channels to more-negative potentials, as most local anesthetics do. In the cerebrospinal fluid of healthy individuals, its concentration was about 3 &mgr;M, whereas in patients with multiple sclerosis and Guillain-Barre syndrome, it increased 300-1,400%. At these concentrations, the peptide’s blocking efficacy was higher than that of 50 &mgr;M lidocaine. At a concentration of 10 &mgr;M, lidocaine is able to ‘unmask’ subclinical lesions in multiple sclerosis; thus, the endogenous pentapeptide may well contribute to the fast changes of symptoms. Furthermore, it may become valuable as a marker of disease activity.

PMID: 10888931, UI: 20348033

I had my right hip replaced on April 20th, which was a complete success. I told the anesthesiologist “No Lidocaine or other Sodium Channel Blockers, and No vasopressors.” He had planned to give me an Epidural block, but after our conversation he did not, and just used Morphine with a nurses aid at my side. I get my left hip replaced on June 16th.

Best Regards.

Jethro

I’ve known of others who can go w/o pain-killers? But not me! No way, no HOW!!!! I know I’d be hanging from the accoustical ceiling like Bill The Cat!
Jethro’s got it on target? The MS folks caught on to the cause/effect aspects early and we can and do learn from them. They’re the ones who are keen about being careful w/many anathestics. Their demeyelination is in the brain? Ours is everywhere else… But the effects are the same.
My own dentist uses alternatives to epinepherine….Jdunk is very right there! They don’t last as long? But they can do the job as needed. Only other problem? IF you have to have one long-time job done on a tooth? Expect to be injected multiple times. My own dentist ‘times’ the work on my mouth to the #’s of teeth that need to be done. I really have a hard time getting up out of the ‘chair’ after 90 minutes. So I am allowed breaks every now and then.
I sooo love the concept of pre-numbing the injection sites! It makes life soo much easier! Each time I leave the dentists’ offices? I go WHOO! Got away alive again! And, mind you, I am NOT dental phobic! Great work Gary!

I’m glad I came across this post today.

Emily is going to the dentist tomorrow and will have to have a tooth removed. Her front baby tooth hasn’t fallen out & the adult tooth is coming in – in front of it.

I’m going to take this info with me.

Kelly

[QUOTE=Emily’s_mom]I’m glad I came across this post today.

Emily is going to the dentist tomorrow and will have to have a tooth removed. Her front baby tooth hasn’t fallen out & the adult tooth is coming in – in front of it.

I’m going to take this info with me.

Kelly[/QUOTE]

Epinephrine isn’t typically used in kids, but of course, make sure. The epi is the offending agent for CIDP.

Good luck at the dentist to both of you…Hope it goes well!!

I have used lidocaine (I don’t know if with epinephrine) for several procedures (lumbar puncture, dental crowns, cataract surgery) with no ill effect. I am neither encouraging nor discouraging its use, just providing another data point for you to consider. [URL=http://www.rxlist.com/xylocaine-drug.htm] has a wealth of information on lidocaine.

While the article Jethro points out is not about lidocaine (it is neither a pentapeptide nor endogenous), the caution about the sodium-channel blocker is still warranted and should be discussed with your doctor. By the way, I could not link to the website Jethro posted. Did anybody else have that problem?

~MarkEns

Thanks Jethro. Sorry I couldn’t remember who gave me that advice. 😉 As I am getting closer to 40, my memory is going! It was very helpful and my dentist knew exactly what I was talking about, and I didn’t have to worry about any adverse effects or relapses, so thanks again!

Mark – I was able to access Jethro’s page just fine but couldn’t on yours. I kept getting a message stating the page could not be found.

Thanks for offering another point of view.

Kelly

Sorry, my browser appears to be set to automatically insert hyperlinks into the text, which vBulletin then converts to a difficult-to-parse string. I have edited it so that is one cuts-and-pastes from http to htm inclusive, it should work.

I was not clear on which URL I could not access. The Nature article URL works fine. The one that starts [URL=http://www.multsclerosis] seems to point to a place-holding site.

~MarkEns

Very interesteing, wondering what else I am missing. jeezzz, just when I thought we had a handle on the do’s and don’ts, I am trying my best and thats all I can do. thanks for bringing this up.

I read the threads about the dentist from the beginning and still the Novocaine or lidocain do not work on me but ceptacain does. My Dentist has worked with me on this and when we tried to go back to the others they would have to send me home and after I was home an hour the Novocaine or lidocain would work. So from now on I either do work without any shot or get the ceptacain. But I have to keep reminding them that I do have a problem because they automatically try to give me the Novocaine or lidocain when they are new assistants. Guess it all comes down to communications again! Also, I had GBS and not CIDP so not sure if that also would change things.

So I took Emily to the dentist. She has 2 spots that could turn into cavities if left alone on baby teeth. So she’s supposed to go back in 2 weeks to get those done in silver. She also has a deep ridge on an adult tooth & we are going to get that taken care of with some white stuff (can’t remember what it’s called).

I told the dr I’d rather stay away from epinephrine, why take a chance when we don’t have to. She sent me a letter today explaining the meds they use have epinephrine & I have to get a letter from Emily’s neuro before they will do any dental work on her.

What do other people use instead of the epinephrine?

Thanks.
Kelly

i have had it twice since diagnosis and everything went fine.