Acute pain serves as a warning of disease or threat to the body. It can be caused by a variety of stimuli including injury, surgery, illness, trauma, or painful medical procedures. Intravenous lidocaine was used in the treatment of chronic neuropathic pain syndromes, such as trigeminal neuralgia and peripheral nerve injury, and showed positive outcomes. Therefore, IV lidocaine may be an effective measure in the treatment of acute pain in adult patients due to its analgesic and antiinflammatory properties. (Masic et al, 2018)
Managing chronic pain is a balance between maximally alleviating symptoms by utilizing a therapeutic regimen that is safe for long-term use. Currently, non-opioid analgesics, NSAIDs, and opioids are some of the medical treatment options, but these have numerous adverse effects and may not be the best option for long-term use. However, Lidocaine can achieve both central and peripheral analgesic effects with relatively few side effects, which may be an ideal compound for managing chronic pain. (Tully et al, 2021)
Systemic lidocaine used in continuous infusion during the peri-operative period has analgesic, anti-hyperalgesic, as well as anti-inflammatory properties. Due to its immunomodulation properties over surgical stress, current evidence suggests that intravenous lidocaine could be used in the context of multimodal analgesia. (Soto et al, 2018)
Based on the current available evidence, lidocaine infusion could be considered in refractory cancer pain where other agents are ineffective. (Lee et al, 2019)
Lidocaine is used as a treatment for a number of headache disorders, most commonly in the form of injections – either in nerve blocks, trigger point injections, or as an intranasal spray for migraine or cluster headache. The use of IV lidocaine as a continuous infusion for the management of chronic headache disorders was first described by Williams for the treatment of medication overuse headache. This was then repeated and expanded on by Rosen et al for other chronic headache disorders.18 Lidocaine infusion has also been used to effectively treat SUNCT/SUNA and trigeminal neuralgia. (Berk et al, 2018)
Masic D, Liang E, Long C, Sterk EJ, Barbas B, Rech MA. Intravenous Lidocaine for Acute Pain: A Systematic Review. Pharmacotherapy. 2018 Dec;38(12):1250-1259. doi: 10.1002/phar.2189. Epub 2018 Nov 9. PMID: 30303542.
Tully J, Jung JW, Patel A, Tukan A, Kandula S, Doan A, Imani F, Varrassi G, Cornett EM, Kaye AD, Viswanath O, Urits I. Utilization of Intravenous Lidocaine Infusion for the Treatment of Refractory Chronic Pain. Anesth Pain Med. 2021 Jan 2;10(6):e112290. doi: 10.5812/aapm.112290. PMID: 34150583; PMCID: PMC8207879.
Soto G, Naranjo González M, Calero F. Intravenous lidocaine infusion. Rev Esp Anestesiol Reanim (Engl Ed). 2018 May;65(5):269-274. English, Spanish. doi: 10.1016/j.redar.2018.01.004. Epub 2018 Feb 26. PMID: 29496229.
Lee JT, Sanderson CR, Xuan W, Agar M. Lidocaine for Cancer Pain in Adults: A Systematic Review and Meta-Analysis. J Palliat Med. 2019 Mar;22(3):326-334. doi: 10.1089/jpm.2018.0257. Epub 2019 Jan 7. PMID: 30614748.
Berk T, Silberstein SD. The Use and Method of Action of Intravenous Lidocaine and Its Metabolite in Headache Disorders. Headache. 2018 May;58(5):783-789. doi: 10.1111/head.13298. Epub 2018 Mar 14. PMID: 29536530.