A Phase II Pilot Study to Evaluate Use of Intravenous Lidocaine for Opioid-Refractory Pain in Cancer Patients

Abstract

Opioid-refractory pain is distressing because it is notoriously difficult to treat. Relief from adjuvant therapies often occurs after a lag time. Retrospective evidence points to a role for intravenous (IV) lidocaine in this setting for pain relief. This study was planned as a randomized, double-blind, placebo-controlled, crossover study in which eligible patients received both lidocaine and placebo infusions separated by two weeks. Primary endpoints were magnitude and duration of pain relief. Fifty patients were included in the study. Pain relief was significantly better (P<0.001) and more patients reported a decrease in analgesic requirements (P=0.0012) after lidocaine infusion than after placebo. Onset of analgesia was noted at a mean of 40+/-16.28 minutes after initiation of infusion of IV lidocaine. Mean duration of this analgesia, 9.34+/-2.58 days after the single infusion, was significantly longer than that for placebo (P<0.01). Side effects observed were tinnitus, perioral numbness, sedation, light-headedness, and headache. All side effects were self-limited and did not require any intervention except termination of lidocaine infusion in one case. These data demonstrate that a single IV infusion of lidocaine provided a significantly greater magnitude and duration of pain relief than placebo infusion in opioid-refractory patients with cancer pain. Side effects were tolerable. It is thus a promising modality worth investigating further to establish guidelines for its use in cancer patients with opioid-refractory pain.

A role for intravenous lidocaine in severe cancer-related neuropathic pain at the end-of-life

“…In keeping with Sharma et al [3], we describe a case in which refractory cancer pain was effectively treated with intravenous lidocaine, exhibiting early analgesic response during infusion. Furthermore, the prolonged analgesic effect of lidocaine was pivotal in achieving the patient's wish of care being delivered at home through the provision of sustained pain relief at the end-of-life.…”

“…Systemic delivery of lidocaine has been used for analgesic effect for many years, and both intravenous and subcutaneous delivery have been utilised in the palliative setting [1,3,4].…”

A Multicentre Open-Label Safety and Efficacy Study of Tetrodotoxin for Cancer Pain

“…It is noteworthy that the intravenous administration of lidocaine, another sodium channel blocker, can produce long-lasting analgesia. In cancer patients with opioid-refractory pain, mean duration of analgesia was 9.3 ± 2.6 days after a single infusion 18 . For intractably painful diabetic neuropathy, intensity of pain was diminished for up to 28 days after an infusion 19 .…”

Pharmacological Management of Cancer-Related Pain

“…One study in patients with cancer with refractory pain showed improved analgesia with a single dose of lidocaine. 165 The recommended starting dose is 1 to 5 mg/kg infused for 20 to 30 minutes. In patients who are frail, lower doses may be needed.…”