Intra-Venous Lidocaine to Relieve Neuropathic Pain: A Systematic Review and Meta-Analysis

Abstract

Background: The prevalence of neuropathic pain is estimated to be between 7 and 10% in the general population. The efficacy of intravenous (IV) lidocaine has been studied by numerous clinical trials on patients with neuropathic pain. The aim of this systematic review and meta-analysis was to evaluate the efficacy of IV lidocaine compared with a placebo for neuropathic pain and secondly to assess the safety of its administration.Methods: A literature search on PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Google scholar databases was performed for relevant studies published up to February 2019. Randomized controlled trials (RCTs) evaluating IV lidocaine treatment for pain relief in patients with neuropathic pain were included.Results: 26 articles met the inclusion criteria. Patients with varied etiology of neuropathic pain were among the patient samples of these studies. Fifteen articles were included for quantitative analysis. Lidocaine was superior to a placebo in relieving neuropathic pain in the early post-infusion period [Mean Difference (MD) = −11.9; 95% Confidence interval (CI): −16.8 to −7; p < 0.00001]. Multiple infusions of lidocaine over a period of 4 weeks, however, had no significant effect on reliving neuropathic pain (MD = −0.96; 95% CI: −2.02 to 0.11; p = 0.08). IV lidocaine was also associated with a significant number of adverse events compared to a placebo [Odds Ratio (OR) = 7.75; 95% CI: 3.18–18.92; p < 0.00001].Conclusion: Our study indicates that while IV lidocaine is effective in pain control among patients with neuropathic pain in the immediate post-infusion period, it does not have a long-lasting, persistent effect. IV infusions of the drug are associated with an increased risk of side effects compared to a placebo. However, the risk of serious adverse events is negligible. Further, well-designed RCTs evaluating the effects of various dosages and infusion periods of IV lidocaine are required to provide clear guidelines on its clinical use.

Dramatic Response to Lidocaine Infusion for Pain from Brachial Plexus Avulsion Injury

“…This case demonstrates how the cycle of secondary pain sensitization and "wind-up" following nerve injury can be broken, with sustained pain relief lasting well beyond any presence of the drug itself (10,14). Despite a recent systematic review (14) concluding that there was no evidence from randomized controlled trials of lidocaine infusion having a prolonged duration of effect, this phenomenon has been observed frequently in clinical practice (14), one study reporting pain relief lasting at least 3 weeks in 8% of 98 tertiary chronic pain clinic patients.…”

“…A study in 16 patients with CRPS compared computer-controlled short intravenous lidocaine infusions (20 minutes at different target blood levels) with diphenhydramine, and found benefit for lidocaine, particularly a decrease in cold-induced pain, allodynia, and spontaneous pain. The remainder of the medical literature on lidocaine infusions is for a variety of other pain syndromes (10,11).…”

Inhibition of Fast Nerve Conduction Produced by Analgesics and Analgesic Adjuvants—Possible Involvement in Pain Alleviation

“…Local anesthetics have been used for the treatment of the neuropathic pain with an expectation of the inhibition of nerve AP conduction in animals [ 225 , 226 ] and humans [ 227 , 228 , 229 , 230 ], although other effects including neurotransmitter receptor and TRP channel activation are possibly involved in antinociception [ 231 ]. Many of local anesthetics reduce both voltage-gated Na + and K + channel current amplitudes ([ 71 ]; see [ 76 , 231 , 232 ] for reviews).…”

Lidocaine infusions in chronic pain management: A prospective case series analysis

“…13 Furthermore, a 2019 meta-analysis concluded that IV lidocaine is effective in relieving neuropathic pain immediately after treatment, but not over the course of weeks. 14 Currently, there is sparse data on longer-term outcomes, of weeks to months, in patients with chronic pain conditions undergoing lidocaine treatment. Our study aims to evaluate whether a single IV lidocaine infusion offers sustained pain relief, and/or improvements in quality of life, in a population of patients with chronic pain.…”