IV Lidocaine Infusion Therapy

Lidocaine is a medication most people know as a local anesthetic. Given intravenously at carefully controlled doses, it can also influence abnormal nerve activity.

Pain associated with nerve injury or abnormal nerve signaling can become amplified, leaving the nervous system persistently oversensitive. IV lidocaine may reduce this excitability and decrease the transmission of certain pain signals.

IV lidocaine for chronic pain is generally considered an off-label treatment. Lidocaine is a long-established medication, but its intravenous use specifically for chronic pain is not an FDA-approved indication. Clinical research suggests it may provide relief for some patients with refractory neuropathic pain, though response varies by diagnosis and individual.

Lidocaine is not appropriate for every type of chronic pain. Your physician will determine whether the characteristics of your pain suggest an infusion is a reasonable option.

Neuropathic pain can occur when nerves or the nervous system become damaged, irritated, or abnormally sensitive. Patients often describe it as:

• ✦Burning
• ✦Shooting
• ✦Electric
• ✦Tingling, or pins and needles
• ✦Numbness
• ✦Hypersensitivity to touch
• ✦Pain from normally non-painful contact

Lidocaine may reduce abnormal electrical activity in pain-sensing nerves and decrease excessive pain signaling. Clinical studies have found that some patients with refractory neuropathic pain experience meaningful reduction following IV lidocaine — though not everyone responds, and the duration of benefit varies considerably.

Complex Regional Pain Syndrome can cause persistent pain, sensitivity, swelling, and other changes affecting an extremity.

Because abnormal peripheral nerve activity and sensitization may contribute to CRPS, IV lidocaine has been investigated as an option for selected patients. Some experience a reduction in pain and hypersensitivity following infusion. Responses are variable, and treatment should be individualized based on diagnosis, previous treatment history, and medical risk factors.

For patients who respond, IV lidocaine may:

• ✦Reduce pain intensity
• ✦Decrease burning, shooting, or electric pain
• ✦Reduce hypersensitivity to touch
• ✦Improve tolerance of physical activity
• ✦Make participation in physical therapy easier
• ✦Improve sleep when pain is disrupting it
• ✦Improve daily functioning and quality of life
• ✦Potentially reduce the need for some rescue pain medications

The goal is meaningful improvement, rather than necessarily eliminating all pain.

Before treatment, your physician reviews your medical history, medications, allergies, cardiovascular history, and other factors that could affect safety.

A small IV catheter is placed in your arm or hand, and lidocaine is administered slowly under medical supervision. The infusion commonly takes approximately 30 to 120 minutes depending on the protocol, dose, diagnosis, and your individual response. You remain awake throughout.

Your medical team monitors you during the infusion. Depending on your risk factors and the clinical protocol, monitoring may include blood pressure, heart rate, oxygen saturation, cardiac rhythm, and your symptoms and level of alertness.

Some patients notice little during treatment. Others may experience temporary effects such as:

• ✦Lightheadedness or dizziness
• ✦Drowsiness
• ✦Tingling or numbness
• ✦Metallic taste
• ✦Mild nausea
• ✦A feeling of warmth
• ✦Temporary visual or auditory changes

Tell your medical team immediately if you experience unusual or concerning symptoms.

Some patients notice a reduction in pain during or shortly after the infusion; others notice improvement only after treatment is complete.

There is no guaranteed duration of benefit. Some patients experience relief for several hours or days, while others improve for several weeks or longer. Research has shown considerable variation, with some studies reporting relatively short-term analgesia and others longer-lasting improvement in selected patients.

For that reason we do not promise a specific duration of relief. Instead, we assess whether the treatment produces a clinically meaningful improvement in your pain and your ability to function.

An infusion can also serve as a therapeutic trial: meaningful improvement may help your physician determine whether abnormal nerve signaling is a significant contributor to your pain.

There is no single universally accepted schedule for repeating IV lidocaine infusions for chronic pain. If you improve meaningfully and the benefit eventually wears off, your physician may consider another infusion after reassessing your condition.

Timing may depend on how much relief you experienced, how long it lasted, improvement in your function, any side effects, your medical history, other medications and treatments, and whether the expected benefit continues to outweigh the potential risks.

Repeat treatment should be individualized rather than automatically scheduled at a fixed interval.

In appropriately selected patients, with appropriate dosing and monitoring, IV lidocaine can generally be administered safely. It is not, however, risk-free.

Lidocaine can affect the nervous and cardiovascular systems if blood concentrations become too high, which is why patient selection, dosing, monitoring, and access to appropriate medical treatment matter during an infusion.

Potential side effects include:

• ✦Dizziness or lightheadedness
• ✦Nausea
• ✦Drowsiness
• ✦Tingling or numbness
• ✦Metallic taste
• ✦Headache
• ✦Visual changes
• ✦Ringing in the ears
• ✦Temporary changes in blood pressure or heart rate

Rarely, excessive lidocaine exposure can result in serious toxicity, including confusion, seizures, significant cardiovascular effects, abnormal heart rhythms, low blood pressure, or loss of consciousness.

Lidocaine infusion is not appropriate for everyone. Your physician will carefully evaluate patients with conditions such as:

• ✦Significant heart rhythm or conduction abnormalities
• ✦Serious cardiovascular disease
• ✦Significant liver disease
• ✦Certain seizure disorders
• ✦Previous serious reactions to lidocaine or related local anesthetics

Lidocaine is metabolized primarily by the liver, so significant liver impairment may require additional precautions. Your physician will also review your medications and any recent procedures involving local anesthetics to help minimize total lidocaine exposure.

IV lidocaine is not intended to replace every other treatment for chronic pain. For many patients, the best approach combines several strategies that address different aspects of the problem.

Depending on your diagnosis, your plan may include medications, physical therapy, exercise and rehabilitation, targeted injections or nerve blocks, behavioral strategies for pain coping, and other appropriate interventions. Our physicians use lidocaine infusion selectively, when the potential benefits fit the individual patient.