Role of Intravenous Lidocaine Infusion in the Treatment of Peripheral Neuropathy

Abstract

This is a comprehensive review of the literature regarding intravenous lidocaine infusion to treat peripheral neuropathy. The clinical symptoms of peripheral neuropathy occur on a broad spectrum and stem from many etiologies resulting in complex treatment approaches. This review presents the background, evidence, and indications for the use of intravenous lidocaine infusions as a treatment option for this condition. Recent FindingsThe clinical range of peripheral neuropathy symptoms includes pain, numbness, muscle weakness, paresthesia, balance difficulty, and autonomic dysfunction. However, severe neuropathic pain remains one of the most debilitating symptoms that significantly affects the quality of life. Current treatment options include antidepressants, anticonvulsants, and, in some cases, opiates, but these are often ineffective, creating the need for other therapeutic approaches. The pathophysiology of neuropathic pain involves sodium channels which create abnormal pain responses. Intravenous lidocaine primarily functions by inhibiting membrane sodium channels which desensitize peripheral nociceptors, thus creating an analgesic effect. The research in using intravenous lidocaine for neuropathic pain is not fully complete and requires further evaluation.

Treatment Algorithm for Cancerous Wounds: A Systematic Review

“…Systemic lidocaine and ketamine have been frequently used in palliative care for the treatment of neuropathic pain in the last decade, but there is no consensus on the route of administration and applied doses. Efficacy data are also conflicting [ 34 , 35 , 36 , 37 , 38 , 39 ]. Preventing dressing pain fast acting opioids (transmucosal or parenteral fentanyl, sublingual methadone), parenteral or nasal ketamine and nitrous oxide may help [ 35 , 40 , 41 , 42 ].…”

Off‐label pharmacological treatment for neuropathic pain: A Delphi study by the Spanish Pain Society Neuropathic Pain Task Force

“…There are reports on the safety and efficacy of repeated intravenous lidocaine 3–5 mg/kg 30‐minute infusions in reducing pain intensity in certain NP conditions, 46–48 but they have been played down as they were neither long‐lasting nor followed by meaningful functional improvements 46,49 . Notwithstanding, the panelists noted that analgesic efficacy could be maintained if repeatedly dosed at small amounts.…”

“…Modest improvements could be achieved with an authorized vaporized combination of low-dose tetrahydrocannabinol and high-dose cannabidiol in patients with varied NP conditions, such as diabetic neuropathies, peripheral neural lesions, plexus avulsion or multiple sclerosis, who can be reliably monitored and followed-up (B) Implications for future clinical research a. Lacosamide, low-dose naltrexone, propofol, and ketamine have peculiar mechanisms of action that may represent new therapeutic avenues that deserve further study a. Positive results could be expected in future studies of topical sevoflurane to alleviate chronic venous ulcer pain and highconcentration capsaicin patches for phantom limb pain and complex regional pain syndromes infusions in reducing pain intensity in certain NP conditions, [46][47][48] but they have been played down as they were neither long-lasting nor followed by meaningful functional improvements. 46,49 Notwithstanding, the panelists noted that analgesic efficacy could be maintained if repeatedly dosed at small amounts.…”

Novel Drug Targets and Emerging Pharmacotherapies in Neuropathic Pain

“…Lidocaine patches or topical creams are commonly applied directly to the affected area, providing localized pain relief [ 83 ]. Additionally, lidocaine can be administered intravenously [ 84 , 85 ] or orally in the form of sustained-release formulations [ 86 ], allowing for systemic distribution and prolonged analgesic effects.…”

“…However, in a single site randomized double-blind crossover trial, IV lidocaine infusion’s (5 mg/kg effectiveness was compared to active placebo infusion containing diphenhydramine (50 mg) in patients with chronic peripheral neuropathic pain, resulting in no significant long-term pain relief or improvement in quality of life [ 85 ]. Nevertheless, in a comprehensive literature review, the use of intravenous lidocaine infusion as a treatment for peripheral neuropathy was investigated, showing its effectiveness as a treatment option with minimal side effects [ 84 ]. Lidocaine can also be used in the form of sustained-release capsules, transmucosal patches, or oral gels/suspensions to exert longer lasting pain relief in cases of chronic or neuropathic pain [ 88 , 89 , 90 , 91 , 92 ].…”