I am shocked at the misinformation regarding lidocaine that has circulated the media news sites and blogosphere as it relates to major league baseball player Roger Clemens. The addition of lidocaine to a B-12 injection didn’t seem unusual to me or even in need of an explanation. I didn’t think I need bother to comment upon it; surely, someone would explain it.
ESPN interviewed two “experts” – Dr. Ken Dretchen, pharmacology department chair at Georgetown University and Dr. John F. Dombrowski, director of pain medicine at the Washington Pain Center. They were clueless. Amazing. But I definitely won’t hold it against them. They are most certainly experts in their respective fields, just not experts on doping.
Instead of spending the last decade in the ivory tower, my past decade was spent around a subculture where injections of anabolic-androgenic steroids and other performance-enhancing drugs were commonplace and frequent. After reading the ESPN interview (see below for the relevant excerpt), I can take it no more. I will explain the inexplicable.
Athletes who have extensive experience with injectable androgens and PEDs have learned that some substances “hurt” considerably more than others when injected. I am not referring to the pain of the needle, but pain/discomfort/irritation resulting from the actual bolus that is injected intramuscularly. Lidocaine is a local anesthetic that numbs the area temporarily thereby alleviating the pain resulting from the bolus. I have heard that B-12 shots tend to be more painful than, say testosterone enanthate. But honestly, most athletes who are going to resort to needles/syringes are generally going to inject something more than B-12.
So that was my lay explanation of why lidocaine was included. For an expert explanation, see below:
1. What is lidocaine, and how does it work?
Dr. Ken Dretchen…: It’s a member of a class of compounds that work as local anesthetics, which means it’s injected close to where there’s a nerve area to decrease sensation and pain by deadening the nerve fibers.
Dr. John F. Dombrowski…: We’ve all had experiences with it. We’ve gone to the dentist and had a tooth numbed up, or a dermatologist to get a wart or mole removed. They inject it under the skin to make it numb.
2. So would it work for joint pain?
Dr. Dretchen: Joint pain means you have pain fibers being excited, being set off with irritation or inflammation. If you inject lidocaine near those nerve fibers, you can decrease their transmission of pain signals. However, most people would treat [joint pain] with anti-inflammatory drugs.
Dr. Dombrowski: In our practice, I use local anesthetics for what is known as myofascial pain — run of the mill, my neck or back hurts, muscular-skeletal pain that comes from stress or overuse. If you’re working at a computer desk all the time and your neck and shoulders are in knots, and you can push on that spot and say, “Oh my God, it hurts,” that’s the perfect spot for an injection. And if we’re using that, we’re probably also using a little bit of steroids.
4. …So would it make sense for a pitcher to inject lidocaine?
Dr. Dombrowski: If it’s your pitching arm, I could see injecting the shoulder to loosen up, throw some better heat. That’s not unreasonable.
5. How long do the pain-relieving effects of lidocaine last?
Dr. Dombrowski: It’s very short-lived. Four, six, maybe eight hours at most. Local anesthetics are a Band-Aid approach. They help you feel a little bit better. Lidocaine would not do anything about joint inflammation.
6. Can you get pain relief in your joints by injecting lidocaine into your, well, buttocks?
Dr. Dombrowski: No. Never. Unless Clemens was limited by hip pain or whatever in his buttocks, then no, that’s not what you do. You use big deep muscles for injecting steroids. But you would never treat shoulder or elbow pain in that way. If what he was injected with was truly lidocaine, his butt cheek would be numb. And that’s it.
Dr. Dretchen: Just a blind injection into the gluteus area, that would be a strange usage of the drug. When you go to the dentist, would you get an injection into your arm? Of course not.
But you say Roger Clemens told everybody the B-12 and lidocaine were for joint pain. I really think he was only referring to the B-12 and not the lidocaine. I honestly don’t know why Clemens felt it necessary to identify lidocaine by name as something injected along with B-12; that’s almost like saying he took a couple of Tylenol pills containing acetaminophen and stearic acid (an innocuous filler ingredient). Sadly, he probably doesn’t know the purpose of the lidocaine either.