Intermittent Lidocaine Infusion for Refractory Neuropathic Cancer Pain

Key Message : Lidocaine is a sodium channel blocker and N-methyl-D-aspartate receptor blocker frequently used as a local anesthetic and antiarrhythmic. Little is known about the utility of systemic lidocaine in pain management. This case study presents the potential benefits of intermittent lidocaine infusions in a patient with treatment-resistant cancer-related neuropathic pain.

Abstract:

Introduction: Lidocaine is a novel treatment option for neuropathic cancer pain. There are many ways in which it exerts its analgesic effects in the nervous system (Yang, et al., 2020). This case illustrates the utility of lidocaine infusions for refractory cancer pain.

Case: Patient was a 57-year-old male with diagnosis of basal cell carcinoma with associated ulcerating right lateral neck wound. He reported sharp, shooting, burning pain down his neck into his right arm and hand. He had previously tried oral morphine, hydromorphone, oxycodone, methadone, ketamine, gabapentin, pregabalin, duloxetine, hydromorphone and fentanyl infusions with minimal improvement. Alternative treatment options were explored. Patient desired to maintain wakefulness to preserve his quality of life. We administered lidocaine 5mg/kg intravenously via PICC over 1 hour. Vitals were monitored prior to, after 30 and 60 minutes. Patient was assessed every 15 minutes. He tolerated the infusion without side effects. His vitals remained stable. Patient’s self-reported pain score was reduced by 50%. Results lasted approximately 2 weeks. A second infusion was completed with similar results. A third infusion was completed 2 weeks later with reduction in pain score by 25%. Given decreased response, we proceeded with 10mg/kg lidocaine infusion over 2 hours for patient’s fourth infusion. He reported 50% reduction in pain score. As patient’s disease progressed, his pain returned sooner, after approximately 7 days. We increased the frequency of lidocaine infusions to weekly with reported 25-50% reduction in pain scores. He received a total of 8 lidocaine infusions over 3 months. He died approximately 2 weeks after his last infusion.

Conclusion: Lidocaine is a safe, effective option for complex cancer pain. Observational studies have shown no severe adverse events with lidocaine infusion (Chon, Yeo, 2021). Further research is needed to determine the most effective dose and frequency of lidocaine administration for pain management.

References: 1. Yang, X., Wei, X., Mu, Y., Li, Q., & Liu, J. (2020). A review of the mechanism of the central analgesic effect of lidocaine. Medicine, 99(17), e19898.
2. Chong, P. H., & Yeo, Z. Z. (2021). Parenteral lidocaine for complex cancer pain in the home or inpatient hospice setting: a review and synthesis of the evidence. Journal of Palliative Medicine, 24(8), 1154-1160.