Lidocaine Infusion for Chronic Pain

Coverage Decision

Intravenous infusion of lidocaine for chronic pain is considered investigational and is not covered except under the provisions of WAC 296-20-02850 (When may the department cover controversial, obsolete, investigational or experimental treatment?).

There is insufficient high quality evidence to demonstrate that intravenous infusion of lidocaine is safe and effective for managing chronic pain or that its use for this indication is curative/rehabilitative. Supportive evidence is limited, primarily, to short-term pain improvement in selected neuropathic pain conditions.

References: 

  1. Challapalli V, Tremont-Lukats IW, McNicol ED, Lau J, Carr DB. Systemic administration of local anesthetic agents to relieve neuropathic pain. Cochrane Database Syst Rev. 2019 Oct 7;2019(10).
  2. Iacob E, Hagn EE, Sindt J, Brogan S, Tadler SC, Kennington KS, Hare BD, Bokat CE, Donaldson GW, Okifuji A, Junkins SR. Tertiary Care Clinical Experience with Intravenous Lidocaine Infusions for the Treatment of Chronic Pain. Pain Med. 2018 Jun 1;19(6):1245-1253.
  3. Kim YC, Castañeda AM, Lee CS, Jin HS, Park KS, Moon JY. Efficacy and Safety of Lidocaine Infusion Treatment for Neuropathic Pain: A Randomized, Double-Blind, and Placebo-Controlled Study. Reg Anesth Pain Med. 2018 May;43(4):415-424.
  4. Mayhew A, Argaez C. Intravenous lidocaine for chronic pain: a review of the clinical effectiveness and guidelines. Ottawa: CADTH; 2018 Jan (CADTH rapid response report: summary with critical appraisal).
  5. Moulin DE, Morley-Forster PK, Pirani Z, Rohfritsch C, Stitt L. Intravenous lidocaine in the management of chronic peripheral neuropathic pain: a randomized-controlled trial. Can J Anaesth. 2019 Jul;66(7):820-827.
  6. Tan X, Ma L, Yuan J, Zhang D, Wang J, Zhou W, Cao S. Intravenous infusion of lidocaine enhances the efficacy of conventional treatment of postherpetic neuralgia. J Pain Res. 2019 Aug 20;12:2537-2545.
  7. Tremont-Lukats IW, Hutson PR, Backonja MM. A randomized, double-masked, placebo-controlled pilot trial of extended IV lidocaine infusion for relief of ongoing neuropathic pain. Clin J Pain. 2006 Mar-Apr;22(3):266-71.
  8. Van den Heuvel SAS, et al.Intravenous Lidocaine: Old-School Drug, New Purpose-Reduction of Intractable Pain in Patients with Chemotherapy Induced Peripheral Neuropathy. Pain Res Manag. 2017.
  9. Wilderman I, Pugacheva O, Perelman VS, Wansbrough MCT, Voznyak Y, Zolnierczyk L. Repeated Intravenous Lidocaine Infusions for Patients with Fibromyalgia: Higher Doses of Lidocaine Have a Stronger and Longer-Lasting Effect on Pain Reduction. Pain Med. 2019 Oct 16:pnz251. 
  10. Yousefshahi F, Predescu O, Francisco Asenjo J. The Efficacy of Systemic Lidocaine in the Management of Chronic Pain: A Literature Review. Anesth Pain Med. 2017 Apr 22;7(3):e44732.