Subcutaneous lidocaine for treatment of neuropathic cancer pain

Brose, William G.; Cousins, Micheal J.

doi:10.1016/0304-3959(91)90180-6

Cited by 117 publications

(57 citation statements)

References 26 publications

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“…If lidocaine appears to be effective but pain recurs, long-term systemic local anesthetic therapy can be accomplished using an oral local anesthetic, typically mexiletine (Mexitil ® ; Boehringer Ingelheim Pharmaceuticals, Inc.; Ridgefield, CT). For rare patients with refractory neuropathic cancer pain who respond only to intravenous lidocaine infusion, long-term subcutaneous administration has been reported to provide sustained relief [76].…”

Section: Oral and Parenteral Local Anestheticsmentioning

confidence: 99%

Adjuvant Analgesics in Cancer Pain Management

2004

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Adjuvant analgesics are defined as drugs with a primary indication other than pain that have analgesic properties in some painful conditions. The group includes numerous drugs in diverse classes. Although the widespread use of these drugs as first-line agents in chronic nonmalignant pain syndromes suggests that the term "adjuvant" is a misnomer, they usually are combined with a less-than-satisfactory opioid regimen when administered for cancer pain. Some adjuvant analgesics are useful in several painful conditions and are described as multipurpose adjuvant analgesics (antidepressants, corticosteroids, α α 2 -adrenergic agonists, neuroleptics), whereas others are specific for neuropathic pain (anticonvulsants, local anesthetics, N-methyl-D-aspartate receptor antagonists), bone pain (calcitonin, bisphosphonates, radiopharmaceuticals), musculoskeletal pain (muscle relaxants), or pain from bowel obstruction (octreotide, anticholinergics). This article reviews the evidence supporting the use of each class of adjuvant analgesic for the treatment of pain in cancer patients and provides a comprehensive outline of dosing recommendations, side effects, and drug interactions. The Oncologist 2004;9:571-591

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Section: Oral and Parenteral Local Anestheticsmentioning

confidence: 99%

Adjuvant Analgesics in Cancer Pain Management

2004

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“…4,5 Lidocaine's efficacy has recently been confirmed and reviewed in a meta-analysis by Tremont-Lukats, et al 6 Nonetheless, little has been published to clarify the degree of relief which can be expected, and the proportion of patients who will achieve relief. Furthermore, little has been done to identify the patients most likely to benefit from systemic lidocaine.…”

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confidence: 99%

Multivariate Analysis of Chronic Pain Patients Undergoing Lidocaine Infusions: Increasing Pain Severity and Advancing Age Predict Likelihood of Clinically Meaningful Analgesia

Carroll

Gaeta

Mackey

2007

The Clinical Journal of Pain

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Objectives-The proportion of chronic pain patients with suspected neuropathic pain who will have clinically meaningful pain relief with intravenous (IV) lidocaine and the clinical characteristics that identify these patients have not been described previously.Methods-We conducted a cohort study of 99 patients who underwent IV lidocaine infusions for suspected neuropathic pain. An 11-point Numerical Rating Score (NRS) of pain intensity was recorded at the beginning and end of each infusion. A predefined literature-based criteria for "clinically meaningful" reductions in pain score was used to classify patients as responders or nonresponders. Multivariate logistic regression was used to determine clinical variables that predicted an increased likelihood of being a lidocaine responder.Results-The mean reduction in NRS during lidocaine infusions was 2.34 (95% confidence interval 2.83-1.85, P<0.001). Forty-two percent of patients (95% confidence interval 32.5%-52.8%) had NRS reductions of 30% or greater and met the predefined criteria as lidocaine responders. Univariate and multivariate analyses indicated that advancing age and pain severity significantly increased the odds of being a lidocaine responder. Controlled for all other factors, each decade of advancing age increased the odds of being a lidocaine responder by 36%. Each 1-point increase, on an 11-point scale of baseline pain severity, increased the odds of being a lidocaine responder by 29%.Discussion-IV lidocaine effectively reduces pain in a minority of patients suspected of having neuropathic pain. Pain severity and patient age can be used to target therapy to those most likely to respond. Lidocaine can be safely and effectively administered intravenously (IV) to treat neuropathic pain. 4,5 Lidocaine's efficacy has recently been confirmed and reviewed in a meta-analysis by et al. 6 Nonetheless, little has been published to clarify the degree of relief which can be expected, and the proportion of patients who will achieve relief. Furthermore, little has been done to identify the patients most likely to benefit from systemic lidocaine. One cohort study of IV lidocaine treatment in peripheral neuropathic pain patients reported that response to lidocaine is predicted by the severity of mechanical allodynia, and the degree of sensory impairment. 7 Other variables such as age of patients, pain duration, and pain severity did not significantly impact the degree of relief in response to systemic lidocaine. 7 KeywordsThe same group reported on another cohort of patients with central neuropathic pain treated with IV lidocaine. 8 They reported that lidocaine significantly reduced ongoing spontaneous pain in patients with central neuropathic pain. This study did not evaluate factors possibly associated with analgesia such as age, sex, pain duration, severity, or the degree to which patients had been refractory to previous treatments. 8 The power of these studies to identify factors predicting analgesic response was limited by the small number of patients st...

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“…The IC 50 for lidocaine's inhibition of sodium current in an unstimulated peripheral nerve is ≥200 μM (Hille 1977;Chernoff and Strichartz 1990;Docherty and Farrag 2006). However, when administered systemically, lidocaine is reported to produce substantial relief of neuropathic pain in humans (Boas et al 1982;Brose and Cousins 1991;Rowbotham et al 1991;Galer et al 1996) and profound reversal of tactile allodynia in rats (Abram and Yaksh 1994;Chaplan et al 1995;Sinnott et al 1999) at plasma concentrations ≤2 μg/ml (≤8.5 μM), i.e., over 24-fold less than the in vitro IC 50 .…”

Section: Discussionmentioning

confidence: 95%

The antipsychotic drug, fluphenazine, effectively reverses mechanical allodynia in rat models of neuropathic pain

Dong¹,

Jia²,

Lu³

et al. 2007

Psychopharmacology

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The inhibitory action of fluphenazine on ectopic afferent discharges may be due to its ability to block voltage-gated sodium channels, and this may also provide a mechanistic basis for the drug's antiallodynic effect in animal models of neuropathic pain. In summary, our study demonstrates that the classic antipsychotic drug fluphenazine has antiallodynic properties in multiple rodent models of nerve injury-induced neuropathic pain.

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Subcutaneous lidocaine for treatment of neuropathic cancer pain

Cited by 117 publications

References 26 publications

Adjuvant Analgesics in Cancer Pain Management

Adjuvant Analgesics in Cancer Pain Management

Multivariate Analysis of Chronic Pain Patients Undergoing Lidocaine Infusions: Increasing Pain Severity and Advancing Age Predict Likelihood of Clinically Meaningful Analgesia

The antipsychotic drug, fluphenazine, effectively reverses mechanical allodynia in rat models of neuropathic pain

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