People who can’t go numb from local anesthetic

The people who can’t go numb at the dentist’s – BBC – Jan 1, 2017

I have had problems with local anesthetics, but not dental. I’d love to hear from other people who don’t experience the full effect of anesthetics.

Some people are resistant to local anaesthetic, meaning they must endure dental and medical procedures without such pain relief. And we’re only beginning to understand why.

To Lori Lemon, the doctors all seemed flabbergasted. She had come in to the Mayo Clinic in Jacksonville, Florida, to have a lipoma – a growth of soft fatty tissue under the skin – removed from her elbow. She needed to have the area around the lump numbed for the procedure, but that was proving inexplicably difficult.

All the ways and all the different medications that they had at their disposal – none of them worked,” she says.  

She’d had this problem, local anaesthetic resistance, for as long as she could remember. The first time she remembers it coming up was decades ago at the dentists

He found a handful of stories scattered in the medical literature concerning strange cases where patients claimed local anaesthetic had no effect on them.

Alan Hakim and his colleagues at University College Hospital in London were some of the first scientists to bring these cases to light.

Hakim was helping to run a clinic for people with Ehlers-Danlos Syndrome (EDS), a group of very rare genetic diseases characterised by defects in connective tissue, leading to joint hypermobility, skin that bruises easily and fatigue

But Hakim found that some of these patients reported resistance to local anaesthesia. Instead of going numb, they were having to endure the pain. “It became obvious to us that it was a question we should ask every patient we see in the clinic,” recalls Hakim, who co-authored a short report about the findings in 2005.

One hypothesis is that their tissue is slightly different from non-EDS patients and that might affect how the anaesthetic is absorbed.

Local anaesthetics work by disrupting sodium channels.

These channels conduct positively charged sodium ions – and with them the feeling of pain – to nerve cells.

But there are still some questions over the nuts and bolts of this process.

Filling in the details of that mechanism might explain why some patients find certain drugs – say, articaine instead of lidocaine – work better than others.

One theory proposed for the heightened efficacy of articaine, for example, is that it is more soluble in fat (lipids) and therefore diffuses better through each nerve’s membrane.

It’s also possible that the patients’ nerves may be in slightly different places from the norm, with some evidence that dentists can overcome the problems by changing the location of the injection.

Sometimes local anaesthetic is injected into the tissue under the skin, known as infiltration, and sometimes it is injected into or next to a nerve, what’s called a nerve block.

Hakim says the work done by him and his colleagues has raised awareness among doctors and dentists that local anaesthetic resistance is a genuine problem.

But many today have never heard of it and are sceptical, when first told, that it even exists.

This goes along with the skepticism about pain in general. Because there is no proof, they have to rely on the patient’s word, and they seem more concerned about being fooled by a few than denying pain relief to many.

Some of her patients have told her that their doctor or dentist simply won’t believe them when they say “local anaesthetic doesn’t work on me”.

“I think until there’s that level of proof about it, it’s going to be very difficult to get doctors to accept it,” she says.

‘Missense mutation’

But there’s something else surprising about Lemon’s case: she has never been diagnosed with EDS. Could there be other reasons for her resistance to the anaesthetics?

They asked other members of Lemon’s family whether they experienced the same issue. It turned out that her mother and maternal half-sister shared the apparent resistance, though it wasn’t so pronounced, and yet her father did not.

The next step was to analyse the family members’ genomes. When Clendenen and his colleagues did this, they discovered a genetic defect relating to a specific sodium channel in the body, known as sodium 1.5.

The affected gene, called SCN5A, produces a protein called NaV1.5, which is a major component of this channel.

The type of mutation in question is known as a “missense” mutation, which means that one of the amino acids in the protein is different in people with this genetic quirk.

As a result, the functionality of the protein can be affected. A similar mutation means that people with sickle-cell anaemia, for example, have abnormal haemoglobin – the protein designed to carry oxygen in their blood

A chemical test, however, quickly showed that sodium 1.5 channels were present in peripheral nerves, so a genetic defect related to those channels could – in theory – inhibit anaesthetics in such areas of the body.

It’s not clear what difference is caused by having this mutation, but it could make the sodium channels more likely to remain open, allowing signals to flow to the brain, despite the application of local anaesthetic.

The anaesthetic usually inhibits the flow of sodium and therefore stops a pain signal being delivered from the nerve.

For those who have had to strain through invasive procedures at the doctor’s surgery without pain-relief, or undergo general anaesthetic just to have relatively routine dental work done, there might be fresh hope on the horizon.

“This is really important to get that out there,” says Clendenen.

People don’t believe [these patients] and it’s very frustrating. Even some of my colleagues that I’ve talked to say, ‘I don’t believe it’.

Because of my problem with local anesthetics, I’ve become very apprehensive about medical procedures. Among people with EDS, this is not uncommon, but I didn’t know that earlier in life and suffered a few terribly painful procedures.

I wrote about this in KevinMD: When impossible pain is, in fact, possible

After they inject their “foolproof” local anesthetic, what doctor would believe my complaint of pain when they know I can’t feel anything?

I’d love to hear from others who have had such issues…

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24 thoughts on “People who can’t go numb from local anesthetic

  1. Lis

    I’ve always had trouble going numb at the dentist and it wearing off too quickly. It’s enough of a problem that the thought of being awake for a procedure is terrifying. Thankfully, most dentists I’ve been to are aware of it being a thing and I think use something else or double the dose. But as a kid? I suffered a lot at the dentist because he never believed me. No one did. Not even my parents. I’ve been out for all the surgeries, including having my wisdom teeth removed (which I woke up during, but thankfully still entirely numb). But I think the nerve block for my ESI failed somewhat because I definitely felt the needles going in and had to fight to remain still. It wasn’t the worst pain I ever had, but it was definitely uncomfortable and I was far from relaxed. And the pain afterward was awful and lasted for several days. It’s safe to say I never had another one.

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  2. Victoria A ceo

    I too am resistant to local aenestesia. Have had issues throughout my life with various procedures dental and non-dental. Most recently was not able to get numb for an epidural. The dr was yelling at the aenestesiologist to give me the epidural. So they held me down and did it even though I could feel it. I would love to get tested and an official diagnosis because I am terrified of all procedures now. I also have connective tissue issues with hyper mobility and other connective tissue issues, although they are not debilitating. Would love to join any focus group or even just a group to discuss techniques to manage the problem.

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  3. Judith Strong

    In the past 2 weeks I have 2 procedures at the hospital which involved local anaesthetics, one for my elbow and the other in my shoulder, on both occasion I was in tears and shaking from the pain I felt whilst I tried to stay still for the doctors to continue even though I had local anaesthetics before hand. I was in a lot of pain before the anaesthetics and in even more pain after them.

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    1. Zyp Czyk Post author

      I’m horrified that no one stopped the procedure when you were in so much pain. Did no one notice? Or were you, like I was, intimidated into “cooperating” so that it would be over as soon as possible?

      Do you have EDS? Had you heard about this before?

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  4. Marcia De Oyarzabal

    I do go numb during dental procedures but not with local anesthetics! During my c-section I moved my legs and felt the blade, and while having a saphenectomy i had to endure the whole thing because the doctor didn’t believe I could still feel the laser and Canules going through my veins!
    Both my parents have the same condition.

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  5. Annetta Bennett

    I have this problem and th Doctors will not believe me and continue to give me “Cain” medicines and shots to numb which doesn’t work so I feel and have felt every painful operation. I have had 2 Cateract surgeries, 4 kids, 7 Biopsies, 3 Heart Catherizations, Stitches on cuts in leg, head and buttock, all of my teeth pulled with 6 and 7 teeth at a time, Cervical Polyps removed ( which felt like the Doctor was using a coat hanger), just to name a few. Some of the Doctors say they’re sorry they didn’t believe me sfter it’s over, but I wish they would believe me before they start cutting and operating on me. 2 Doctors said to tell everyone I’m allergic to all the “Cain” medicines and I tell them and this doesn’t work either becus see they don’t believe that either and g on and give it to me. I have been given 7 ifferent kinds of Cain medicines that I know of and probably more and thy didn’t tell me about. My mother had this same problem and went through life in pain like me. She died from a heart attack while getting 2 teeth pulled at age 78.

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    1. Zyp Czyk Post author

      You’ve been literally tortured – how awful. Having had a few of these “interesting” experiences myself, I know what if feels like to have your flesh cut into with scalpels when anesthetic doesn’t work.

      Perhaps you could show doctors this article (and there are more in PubMed) before you have another surgery.

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    2. Sandra McFarlane

      I too, don’t have a problem with dental work, but do with other locals. My first experience was about 15 years ago when a GP removed a large cyst from my back. I told her with the first cut to stop as I could feel the scalpel cutting into my flesh. She continued to tell me I had a very low pain threshold and was really quite rude and disrespectful. After another smaller dose, it was numb. With each following surgery it has been the same, most recently three days ago. I had a colonoscopy where the Dr injected anaesthetic into my hand, I felt slightly dizzy for a minute but was aware of everything being done. By the time It was finished I was covered in sweat with my heart racing. The nurse with me knew it was happening and kept telling me it would all be over soon. I didn’t stop it as I couldn’t handle the thought of going through four days of preparation and the actual procedure again. For some reason I thought with modern technology, I wouldn’t have a problem. For śomeone to actually believe this does happen, would be reassuring, so far it hasn’t been that way. In future I will make my voice heard, why should I suffer to spare someone’s ego, enough is enough. PS: I am 70 years old.

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      1. Zyp Czyk Post author

        Doesn’t it feel a little good to be validated though? Bittersweet, at best… but it puts to rest any notion that we’re just sissies.

        I wonder how our critics would handle – without anesthetic – some of the procedures we’ve been through without effective anesthesia.

        But now I understand what’s going on and I’ll insist on being truly numb before allowing any potentially painful procedures again.

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  6. Barb Edwards

    Locals don’t work on me either. Had 20 teeth extracted 2 weeks ago and it was absolutely the most horrendous experience. I don’t think the dentist really believed I wasn’t numb but she did reinject me over and over and over with different anesthetics to no avail. All the injections were excruciating enough but having your teeth ripped out without being numb is pure torture. I’ve had a myleogram (?), a large cyst cut out of my back and denture procedures in the past with no relief from the pain and no one believing me. Having my 20 teeth pulled without being numb has left me unable to get this off my mind. I will never have another local.

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    1. Zyp Czyk Post author

      What a nightmare! I know I’m lucky that the dental anesthetic works for me, just the one they use for giving stitches is ineffective for me. I don’t know how you were able to sit still while you were being brutalized.

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  7. Donna Wallace

    I am a redhead and local anesthetic doesn’t work at all. It does not matter if it is the Ester or amides. I feel the stick and burn each time. I have been called a liar. I am also a heavy bleeder and pain meds don’t work well. They say I’m a rapid metabolizer. I have teeth no one will pull and some they will not fix. You tell them it doesn’t work and they say it’s in your head. I have also woken during conscious sedation.

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  8. Stephanie Brockmann

    Local anesthetic doesn’t work on me either. Its not just dental work, I’ve had biopsies that I wouldn’t numb up for either. I wasn’t always this way. It happened over a 5 year span. It slowly worked less and less. Now not at all. I recently had 2 roots canals done and had to be put under. My dentist was great but afterwards he told me that I really do have the issue. To my body it’s like water. He said local and oral won’t work on me. Its a frustrating and scary issue to have. Most doctors don’t believe me.

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    1. Zyp Czyk Post author

      You’ll just have to bring the article with you to prove your point.

      I remember having stitches under local anesthetic, yet feeling every stab of the needle through my skin and the awful sensation of the “thread” being pulled through the holes. It’s no wonder I’ve become very distrustful when a doctor tells me “this won’t hurt a bit”.

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  9. Liz

    I wonder if anyone else has issues with topical anaesthetics too? Most of the procedures I’ve had in my lifetime have been under a general anaesthetic which, luckily, I have no problem with. But I began to be aware that something wasn’t right when I had dental work done in 2005 then again in 2015 and in both instances, at two different dental surgeries, nothing the dentist could do would numb me. Yesterday I went in for an endoscopy and the surgeon was amazed and then in disbelief when the local throat numbing spray wasn’t having any impact on me even after three doses. In the end it kicked in for about 30 seconds then stopped working again so we had to postpone the procedure. Has anyone else had this?

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  10. Tamara Freitas

    I am a 31 year old female with a history of unsuccessful dental Numbing procedures done. They essentially do a very deep injection now that seems to have taken care of that problem although I still have waves of sensation I can feel during the procedure. I have most recently had some radiofrequency laser ablations done that the doctor has maxed out the dose of lidocaine that he can give me and I’m still in a huge amount of pain. I most recently had a phlebectomy to my right leg today, again after being maxed out I felt like I was in a torture chamber. I felt many of the incisions, excision and the ripping out of the vein. I have come online to see if there is something wrong with me and why I don’t numb up like I should. I literally just laid through one of the most torturous things in my life. And I have had two children naturally with no epidural that felt less painful than these procedures. I wish I knew why this is happening to me, until then i don’t think I can physically deal with the pain these procedures have caused.

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    1. Zyp Czyk Post author

      You definitely fit the description of anesthetic resistance. I shudder to think of having those veins ripped out without being anesthetized – I wouldn’t believe you could stay still during such horrific pain if I hadn’t experienced something similar, and the strange paralyzed feeling while it’s happening, when you’re afraid to move and slow them down…

      There must be other types of local anesthetic they could try… but if not, I guess you’d have to be put out completely for such procedures.

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  11. john cooper

    Hi There, same problem, no one will believe you – worst experience was for a dupitrons procedure – three arm blocks that didnt work (you would have thought they would have listened after two didnt work but no! I could still use my arm, even able to turn pages in a book.
    My surgery was scheduled for 7.30 am – had it at 2.30……….
    In the end they gave me general anesthetic but couldnt knock me out – it took another 45 minuets…I think I just went to sleep in the end.

    Frustrating that they wont listen!!

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  12. Monica Jarvis

    I’m one that used to get numb as a child but at some point the anesthetics quit working. I had a thyroid biopsy done and couldn’t scream but cried throughout the procedure. You don’t want to yell when they are stabbing your neck with needles. Locals at the dentist will not work no matter how much they give you. I have found a dentist that offers IV sedation. They have me flagged as having anxiety. I’ve tried telling them it isn’t an anxiety issue. I feel so frustrated at times. I had another medical procedure done a few years ago with a local anesthetic. It was a horrible experience. Believe me the pain is real. You absolutely feel everything.

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    1. Zyp Czyk Post author

      I consider myself lucky that it’s only the local anesthetic they give for things like stitches don’t work for me. The dentist has to give me an unusually large dose of their anesthetic, but that one works for me – if it didn’t I’d go for the IV sedation too.

      I’m amazed how we all manage to stay still when we’re undergoing procedures without effective anesthesia. I, too, was petrified with fear and too scared to move for the same reason as you: when they have knives or needles in your body, movement would only cause more pain.

      There are some who just won’t believe their method of anesthesia isn’t working and write it off as anxiety, but if they were facing surgery without anesthetic, they’d realize why we get so anxious about it.

      Because pain is not only invisible, but undetectable and thus unmeasurable, we have to find doctors who take our word for it. These days doctors are usually just employees of some corporation and have to follow “standard procedures” instead of truly “practicing medicine”, and our unique situation isn’t accounted for.

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