A large proportion of people with Joint Hypermobility Syndrome (JHS) and Ehlers Danlos – Hypermobility Type appear to be resistant to local anaesthetics either as topical creams or injections. In one large survey JHS patients were 3 times more likely to report the poor effectiveness of local anaesthetic compared to people without JHS.
The mechanisms that cause this are not understood.
It is important for your dentist or your doctor to know if you have problems with local anaesthetics. Some people will respond to more than the standard dose or to regular top up of more anaesthetic during a procedure. If your dentist or doctor is not familiar with this issue in JHS / EDS then, in the first instance they may be reluctant to give you more anaesthetic. Tell them your situation and this will help them to understand and to help you.
Some people may just not respond at all to local injection anaesthetics. Here, other forms of pain relief or even a general anaesthetic may be the only option.
Dr Alan Hakim MA FRCP
Consultant Rheumatologist and Physician, Barts Health NHS Trust, London
Written June 2013: Planned Date of Review June 2016
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Arendt-Nielsen L, Kaalund S, Hogsaa D, Bjerring P. The response of local anaesthetics (EMLA cream) as a clinical test to diagnose between hypermobility and Ehlers Danlos III syndrome. Scand J Rheumatol 1991; 20: 190-5
Hakim AJ, Norris P, Hopper C, Grahame R. Local Anaesthetic Failure; Does Joint Hypermobility Provide The Answer? Journal of the Royal Society of Medicine 2005; 98(2): 84-5