He said, he said: In the Mitchell report, trainer Brian McNamee claims he injected Roger Clemens with steroids more than a dozen times over the course of three different seasons, usually "in the buttocks."
Meanwhile, Clemens told "60 Minutes" that McNamee never injected him with steroids, but rather with vitamin B-12 and lidocaine, the latter an anesthetic that Clemens claimed was "for my joints."
Does Clemens' explanation make medical sense? Page 2 talked to a pair of experts:
1. What is lidocaine, and how does it work?
Dr. Ken Dretchen, pharmacology department chair, Georgetown University: 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, director of pain medicine at the Washington Pain Center and former president of the D.C. Society of Anesthesiologists: 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.
3. Wait -- steroids?
Dr. Dombrowski: Steroids are like alcohol. There are different kinds. For pain, I'll use a corticosteroid, like a cortisone shot. Those are done to joints and muscles to decrease inflammation. They will never make you big, unlike anabolic steroids such as testosterone. I would never use an anabolic steroid for pain management.
4. Right. 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.
Patrick Hruby is a columnist for Page 2. Sound off to Patrick here.