Effect of Intravenous Lidocaine on the Neuropathic Pain of Failed Back Surgery Syndrome

Abstract

BackgroundAn intravenous infusion of lidocaine has been used on numerous occasions to produce analgesia in neuropathic pain. In the cases of failed back surgery syndrom, the pain generated as result of abnormal impulse from the dorsal root ganglion and spinal cord, for instance as a result of nerve injury may be particularly sensitive to lidocaine. The aim of the present study was to identify the effects of IV lidocaine on neuropathic pain items of FBSS.MethodsThe study was a randomized, prospective, double-blinded, crossover study involving eighteen patients with failed back surgery syndrome. The treatments were: 0.9% normal saline, lidocaine 1 mg/kg in 500 ml normal saline, and lidocaine 5 mg/kg in 500 ml normal saline over 60 minutes. The patients underwent infusions on three different appointments, at least two weeks apart. Thus all patients received all 3 treatments. Pain measurement was taken by visual analogue scale (VAS), and neuropathic pain questionnaire.ResultsBoth lidocaine (1 mg/kg, 5 mg/kg) and placebo significantly reduced the intense, sharp, hot, dull, cold, sensitivity, itchy, unpleasant, deep and superficial of pain. The amount of change was not significantly different among either of the lidocaine and placebo, or among the lidocaine treatments themselves, for any of the pain responses, except sharp, dull, cold, unpleasant, and deep pain. And VAS was decreased during infusion in all 3 group and there were no difference among groups.ConclusionsThis study shows that 1 mg/kg, or 5 mg/kg of IV lidocaine, and palcebo was effective in patients with neuropathic pain attributable to FBSS, but effect of licoaine did not differ from placebo saline.

An Observational Study on Lignocaine Infusion for Intractable Chronic Pain

“…There are several studies reporting significant reduction of pain after lignocaine infusion in PDN and a variety of non-PDN conditions including fibromyalgia [41], headache [42], back pain [43], trigeminal neuralgia [44] and chronic pain syndrome [36,37]. Like previous investigations, the present study also showed a beneficial effect of lignocaine infusion to treat both PDN and non-PDN group.…”

Best Practices in the Treatment of Neuropathic Pain

“…Such interventions should be performed by qualified specialists. Evidence-based data support the use of spinal cord stimulation [42], intrathecal drug delivery [43], intravenous infusion therapies [44,45] and sympathetic nerve blocks for the treatment of neuropathic pain. Interventional options should be used cautiously in clinical practice and reserved for patients that fail conventional therapy.…”

“…Intravenous lidocaine and ketamine infusions have been used in the treatment of neuropathic pain [44,45]. Lidocaine is a sodium channel blocker that is postulated to act centrally [59].…”

The Efficacy of Gabapentin in Patients with Failed Back Surgery Syndrome

“…Spinal cerrahilerden sonra gelişen nöropatik ağrı ile ilgili birçok mekanizmadan bahsedilmektedir. Sinir köklerinin uzun süre bası altında kalmış olması, uygulanan cerrahi esnasında sinirlerin iyatrojenik olarak yaralanması, sinir kökleri veya dorsal kök ganglionundan çıkan ektopik impulslar nöropatik ağrıya neden olabilmektedir (9).…”