Lidocaine infusions


Lidocaine Infusion- An Effective Treatment for Chronic Pain

Pain is experienced by everyone at some point in their lives; it is the uncomfortable, and sometimes even excruciating, feeling caused by an injury. This sensation acts like a warning system, alerting your brain that something is wrong so that the injury can be dealt with and further injury can be prevented. In some individuals, however, pain persists even long after a physical injury has healed; this is called chronic pain.  Pain is a symptom of an injury, whereas chronic pain is a condition itself.

Chronic pain can take a toll on an individual’s life, both mentally and physically, causing a sometimes debilitating decline in quality of life. Finding effective techniques for managing chronic pain is essential and, with advancements in the specialty of pain management, it is also achievable. If you are experiencing widespread pain and your current treatments are not providing you with adequate relief, lidocaine infusion treatment may be an effective option for you.

 

What is lidocaine infusion?

Lidocaine infusion is a nonsurgical, minimally invasive treatment used to relieve chronic, widespread pain caused by certain disorders. Intravenous injections of lidocaine are effective if you are suffering from fibromyalgia, central neuropathic pain that includes spinal cord injuries, or other causalgias. The treatment procedure involves infusion of the numbing agent lidocaine into your body intravenously; this helps reduce pain throughout the body by blocking pain receptors in the brain and spinal cord and numbing the nerves as a result. The treatment is prescribed when standard medications used to treat nerve pain show a lack of effectiveness. Continuous or repeated lidocaine infusion treatment can offer you long-term relief from pain.

 

What are the common conditions for which lidocaine is used?

Lidocaine intravenous infusion is used to minimize the symptoms of chronic pain. Along with relieving neuropathic pain, it has been proven to be effective in treating several types of headaches, as well as pain associated with cancer. Lidocaine infusions are commonly used as an effective and long-lasting form of pain relief for the following conditions:

    • Central and peripheral neuropathic pain
    • Peripheral nerve injury
    • Post-herpetic neuralgia
    • Fibromyalgia
    • Chronic diabetic neuropathy
    • Vascular headaches
    • Persistent postsurgical pain
    • Complex regional pain syndrome
    • Cancer pain
  • Chronic refractory pain

 

Who can benefit?

Patients with Fibromyalgia

Fibromyalgia is characterized by widespread chronic pain associated with sleep disturbance, fatigue, and psychological distress; it is a condition that can have a devastating impact on quality of life.  The symptoms occur due to changes in how the brain and spinal cord process signals, causing pain sensations to be amplified. While fibromyalgia is a difficult condition to manage, and is not responsive to many interventions, recent studies have shown that serial lidocaine infusions are effective in managing the pain in most individuals. Doctors consider IV lidocaine infusions to be an excellent treatment option for fibromyalgia patients who are refractory to other treatments.

 

Patients with Neuropathic Pain

Is neuropathic pain or complex regional pain syndrome adversely affecting your quality of life? In this condition the expression of sodium channels is modified, which causes the unpleasant feeling of pain. An intravenous combination of lidocaine and magnesium has been clinically proven to be an effective treatment for reducing the sensation of pain by sodium channels blocking action. Lidocaine has some additional modes of action that help treat central and peripheral pain. It contains more potent anti-inflammatory properties than other standard anti-inflammatory medicines.

 

Patients with Perioperative Pain

An upcoming surgery has enough reasons to make you anxious; you shouldn’t have to worry about unmanageable pain as well. The use of intravenous lidocaine infusions can reduce or eliminate your perioperative pain effectively. Intravenous local anesthetic infusions can block pain transmission in the spinal cord and reduce the sensation of pain. Some benefits of using this perioperative pain management process include a speedier return of bowel function after surgery and an earlier release from the hospital.

 

Patients with Cancer

If you are a cancer patient, you are likely very familiar with chronic pain. Despite advances in cancer treatment, widespread pain continues to be a predominant problem for patients. Lidocaine infusions have become a very appealing option for cancer pain management due to low cost, ease of administration, and minimal side effects. In addition, lidocaine can be administered to cancer patients repeatedly as required.

 

What are the possible side effects?

Lidocaine is a safe medication compared to other pain available pain medications; however, no drug or medical procedure is entirely risk-free. While the side effects associated with lidocaine infusions are minimal, common side effects include:

  • Swelling, redness, rash, or skin irritation at the site of injection
  • Nausea, vomiting, or constipation
  • Dizziness, headache, slurred speech, drowsiness, or visual changes
  • Numbness around the lips or ringing in the ears

Extremely rare, but serious, side effects include:

  • Changes in blood pressure and heart arrhythmias
  • Allergic reactions
  • Seizures
  • Malignant hyperthermia

While the rare side effects are serious, they are also very rare. Most side effects resolve within one hour of treatment.

 

FAQ

Q: How do I know the medication is working?

A: Although lidocaine infusion is an effective tool for managing pain for most people, a rare minority of people do not respond to this treatment. The following indicators will tell you if the medication is working effectively for you:

  • The sharpness of the pain is reduced by 30% or more
  • You have the ability to participate in activities like physiotherapy
  • You can return to work
  • You can perform household chores or go for walks

Overall, if you are able to carry out your day-to-day activities with more ease and comfort than you could prior to the treatment, your body is responding well to the treatment. If, however, you have not noticed any change in your level of pain, book a follow-up appointment with the physician; you may need to have a change in dosage or a change in medication strategy altogether.

 

Q: How is my dosage decided?

A: Your dose is calculated based on your body weight; the ideal dose of lidocaine is 5mg/kg. While preparing for a continuous lidocaine infusion, a test dose is given. If your body responds well to the test dose, without showing any signs of an adverse effect, the physician will proceed with your infusion treatment.

 

Q: What if I do not respond to the treatment?

A: If you do not experience any significant pain relief from an initial lidocaine infusion, you will receive the same dosage for the next two to three appointments; this is because some patients respond more slowly to the treatment than others and, therefore, require multiple treatments for an effective response. If, after these follow-up treatments, you are still not experiencing significant pain relief, your dosage will be adjusted. Once your appropriate dosage is determined, the treatment can be repeated every three to four weeks, as needed.

 

Q: Who should not have a lidocaine infusion treatment?

A: There are certain medical conditions that make it unsafe to receive a lidocaine infusion treatment. It is imperative that you inform the physician if any of the following apply:

  • You experienced an allergic reaction to an anesthetic in the past. Your doctor will need to know the name of the anesthetic as well as what type of reaction you experienced.
  •  You have a history of heart failure, any degree of heart block, or a seizure disorder
  • Any disorder or disease related to liver or kidney function
  • You are pregnant or breastfeeding, or will do the same in the near future

 

Q: How do I know if lidocaine infusions are not the right treatment for me?

A: If you do not experience substantial reduction in your level of pain, even with the maximum safe dosage, you may be in the small minority of individuals whose bodies do not respond to lidocaine treatments; in this case, your physician can work with you to find an effective alternative. Additionally,  in very rare instances patients experience symptoms including spikes in blood pressure or signs of toxicity; if this is the case, your transfusion will be discontinued. 

Lidocaine infusion is a safe and effective treatment for managing chronic pain conditions with a high rate of success and minimal side effects. Make an appointment with a physician to find out if this treatment is right for you! Be well.

 

Citations

  1. Emily Melikman, Enas Kandil, Bryon Adinoff.  Lidocaine Infusion: A Promising Therapeutic Approach for Chronic Pain, PMC [Published online Jan 11, 2017]<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5323245/#R32>
  2. David M. Marks, Amy Newhouse Durability of Benefit from Repeated Intravenous Lidocaine Infusions in Fibromyalgia Patients: A Case Series and Literature Review, PMC [Published online Sep 17, 2015] <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4732305/>
  3. Igor Wilderman. Repeated Intravenous Lidocaine Infusions for Patients with Fibromyalgia: Higher Doses of Lidocaine Have a Stronger and Linger-Lasting Effect on Pain Reduction, Oxford [Published Online Jan 10, 2019]   
  4. Kara Buck, Hanna Christensen, Marilyn Bazinski. Systemic Lidocaine for the Treatment of Pain-Adult/Pediatric- Inpatient/Ambulatory/Emergency Department Clinical Practice Guideline, UW Health Oct 9, 2019 <https://www.uwhealth.org/cckm/cpg/medications/Systemic-Lidocaine-for-the-Treatment-of-Pain—Adult-Pediatric—IP-Amb-ED-191003.pdf>
  5. IV Lidocaine Infusion, St. Joseph’s Health Care London Pain Management Clinic June 16, 2020 <https://www.sjhc.london.on.ca/patients-and-visitors/online-patient-and-caregiver-resource-library/iv-lidocaine-infusion>
  6. John P. Cunha, Lidocaine, RXList, Aug 13, 2021 <https://www.rxlist.com/consumer_lidocaine_lidopen/drugs-condition.htm>
  7. Jessica Martin, Intravenous Lidocaine Safe, Effective for Chronic Pain, Clinical Pain Advisor [Published online Aug 30, 2017] <https://www.clinicalpainadvisor.com/home/topics/chronic-pain/intravenous-lidocaine-safe-effective-for-chronic-pain/>
  8. Lidocaine Infusion, Desert Pain Specialists <https://desertpainspecialists.com/treatments-2/lidocaine-infusion/>
  9. Intravenous Lidocaine Infusion – Complications, Stanford Health Care <https://stanfordhealthcare.org/medical-treatments/i/intravenous-lidocaine-infusion/complications.html>

 

HOW TO PREPARE FOR YOUR APPOINTMENT

What to bring:

  1. Please bring a current health card.
  2. Make arrangements for someone to drive you home (or some other mode of transportation, such as public transit or taxi) following the procedure, as possible side effects such as drowsiness make it inadvisable for you to drive temporarily.
  3. You will need to follow the relevant COVID-19 protocols for your own safety and that of our staff and other patients. You can find further information about these safety measures at drwilderman.com/covid-19

 

Prior to receiving a lidocaine infusion:

You will have a consultation with the physician prior to your lidocaine infusion to discuss your condition and health history; at this point, the procedure will be explained to you and you have the opportunity to ask questions. It is imperative that you inform the physician if any of the following apply:

  • You experienced an allergic reaction to an anesthetic in the past. Your doctor will need to know the name of the anesthetic as well as what type of reaction you experienced.
  •  You have a history of heart failure, any degree of heart block, or a seizure disorder
  • Any disorder or disease related to liver or kidney function
  • You are pregnant or breastfeeding, or will do the same in the near future
  • You take any medication – prescribed, non-prescribed, over-the-counter or herbal

 

What to expect during your procedure:

During the treatment, you will be positioned comfortably on a bed or trolley and the IV will be sited in a vein on your arm. The lidocaine infusion medication will then be administered; as it enters your bloodstream, your body’s pain response systems will become less sensitive. This process will take approximately 1-1.5 hours. Throughout the procedure you will be monitored by our medical staff for any changes in heart rate or blood pressure or any adverse reactions. In the event that you do experience side effects, they typically resolve within an hour. 

You may experience immediate relief from your pain or the effects may take a little bit longer; the speed of effect varies and, unfortunately, in a very small minority of people the treatment does not provide relief. From a single dose of lidocaine, pain relief typically lasts between one to four weeks. A nurse will be available to answer any questions you might have and review instructions for follow-up care with you. Once your procedure is complete, you are free to go home; please remember to arrange for a safe form of transportation, as it is not safe for you to drive immediately following this procedure.

 

After your procedure:

  • Activities: Rest. Do  not drive for three hours after the procedure. On the day following your procedure, you may resume your normal daily activities.
  • Medication: You may take whatever medications you normally use for pain management.
  • Follow-up: Make an appointment for follow-up. If you experienced significant, lasting pain relief you can repeat the procedure as needed. If, however, you experienced minimal or no pain relief, don’t be discouraged! Talk with your physician about your options.

We recently published an article in 2019 outlining the lidocaine infusion procedure which can be found in the link below.

Lidocaine Research Article.pdf

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