The Efficacy of Systemic Lidocaine in the Management of Chronic Pain: A Literature Review

Abstract

ContextDespite recent advances in the understanding of the chronic pain concept, its diagnosis and management remains a daily challenge for clinicians and patients. Based on the published literature, this review discusses and tries to organize the current knowledge and the up-to-date clinical experience about the efficacy and safety of the use of intravenous lidocaine in treatment and prevention of chronic pain.Evidence AcquisitionTo prepare this narrative review, we performed an in depth literature review using the PubMed searching engine. We extracted all relevant articles published in English, up to April 2016.ResultsLidocaine, administered as transdermal patch or intravenous lidocaine, is a safe and effective modality in the treatment of post-herpetic neuralgia (PHN), complex regional pain syndrome, as well and for prevention of chronic pain. It may be effective in the management of neuropathic pain syndromes, chronic pain, post-operative pain, and refractory cancer pain.ConclusionsIntravenous lidocaine and lidocaine patch are effective and safe for the treatment of several chronic or neuropathic pain syndromes. The use of lidocaine during surgery could prevent the development of some chronic post-surgical pain syndromes.

Efficacy of intravenous lidocaine in improving post‑operative nausea, vomiting and early recovery after laparoscopic gynaecological surgery

“…In addition, intravenous lidocaine may inhibit G protein-coupled receptors, N-methyl-D-aspartate receptors, the release of inflammatory factors and the function of leukocytes. Therefore, it has anti-inflammatory, analgesic, anti-hyperalgesic and immune regulatory effects (33)(34)(35)(36). A previous study indicated that the major mechanism of the anaesthetic action of propofol is the inhibition of sodium channels in the central nervous system, and lidocaine is able to enhance the effect of propofol by also inhibiting sodium channels (37).…”

Lidocaine as an element of multimodal analgesic therapy in major spine surgical procedures in children: a prospective, randomized, double-blind study

“…Recent studies report that perioperative infusion of lidocaine may also have an analgesic effect by affecting postoperative serum concentrations of endocannabinoids, N-acylethanolamines (NAE) and endogenous opioids: β-endorphin, enkephalin and dynorphin [28,29]. Numerous studies and meta-analyzes have shown a positive effect of the perioperative systemic lidocaine administration in adults on the postoperative analgesia, gastrointestinal recovery and duration of hospitalization in major surgery [9,10,13,17,21,30]. However recent meta-analyzes suggest that lidocaine exerts a positive analgesic effect only in abdominal surgery [11,12].…”

“…Recently, it has been reported that lidocaine also beneficially supplements therapy aiming at improving patient comfort in the postoperative period [9][10][11][12][13][14][15][16][17]. However, there are no studies evaluating the intravenous (i.v) lidocaine as an element of analgesic multimodal therapy in spine surgery in children.…”

Nonopioid strategies for managing chronic pain

“…Anesthetics, such as systemic lidocaine, have shown benefit in chronic pain by decreasing hyperalgesia and inflammatory response. 65 While systemic lidocaine has a large quantity of evidence for use, it exists mostly for chronic neuropathic pain syndromes, including postherpetic neuralgia and chronic low back pain secondary to osteoarthritis, and has less evidence for use in acute or nociceptive pain. 65 Sys-temic lidocaine also has inflammatory properties that exceed those of other commonly used anti-inflammatories, with many fewer adverse effects.…”

“…65 While systemic lidocaine has a large quantity of evidence for use, it exists mostly for chronic neuropathic pain syndromes, including postherpetic neuralgia and chronic low back pain secondary to osteoarthritis, and has less evidence for use in acute or nociceptive pain. 65 Sys-temic lidocaine also has inflammatory properties that exceed those of other commonly used anti-inflammatories, with many fewer adverse effects. This has gained lidocaine popularity for treating other, more difficult, chronic pain syndromes, such as complex regional pain syndrome (CRPS) and fibromyalgia.…”