Chronic Pain Management's Future: Lidocaine Infusion Therapy

Chronic Pain and Lidocaine

Chronic pain, characterized by pain lasting longer than 3 months, is an extremely debilitating condition that is often treated with high dosage opioids. This form of treatment is effective in the short-term, but offers little long-term benefit when factors such as increased tolerance, risk of addiction, and significant side effects are considered. These downstream implications can worsen one’s quality of life and steer them further away from long-term pain relief as symptoms are alleviated but the root cause of pain goes untreated.

Lidocaine is normally used as a local anesthetic, but it can also be administered intravenously as a non-opioid analgesic. It works by attenuating the sensitization of peripheral nociceptors, or in other words, reducing one’s sensitivity to pain. In addition to its analgesic properties, lidocaine acts as an anti-inflammatory with greater potency and less side effects than traditional anti-inflammatory medications. These effects are accomplished by reducing the number of cytokines, which are pro-inflammatory molecules that get released into circulation.

Lidocaine's Mechanism of Action

Biochemically, lidocaine functions by inhibiting sodium ion movement at the cellular level, thereby preventing pain receptor activation and the subsequent pain sensation. This process involves increasing sodium concentration within neuronal cells, enabling voltage-gated sodium channels to open and maintain a positive feedback loop. Lidocaine specifically targets and obstructs these channels, which create openings in the membrane for sodium influx. Consequently, this diminishes the neuron's capacity for activation and leads to reduced pain perception.

How is Lidocaine Different?

Historically, chronic pain management has been heavily reliant on the prescription of opioids, which work by binding to the mu class of receptors in our bodies to modulate pain signals via the central and peripheral nervous system. This has been effective for many, but has also come with a considerable cost. Currently, over 3 million individuals in the United States suffer from opioid use disorder (OUD), with a proportion also suffering from opioid-induced hyperalgesia (OIH). These cases of addiction and the generalized heightening of one’s sensitivity to pain are a couple of the many negative societal impacts following modern medicine’s over-reliance on opioid prescriptions. Fortunately, tighter regulations on prescriptions and increased research into alternative therapies has given new hope for the future of chronic pain management. Lidocaine is one such therapy.

Lidocaine, as previously mentioned, works by decreasing the activation of pain receptors in neurons by decreasing the sodium influx. This unique mechanism of action provides some additional benefits over opioid therapy. In particular, the ability for long term opioid usage to increase one’s pain sensitization threshold and their perception of pain leads to the patient needing stronger or higher-dosed opioids. Since lidocaine works on sodium receptors rather than mu receptors, it carries additional involvement in reinforcement and reward mechanisms, mood regulation, and even stress. As a result, the therapy offers more ways of providing relief and may help to prevent increased pain sensitivity, opioid tolerance, and opioid utilization. 

The Present and Future of Lidocaine Infusion Therapy 

In the world of pain management, and chronic pain therapy, lidocaine is a relatively new but very promising therapy. It has recently begun to be more widely used and shown improvement of pain in conditions like fibromyalgia, diabetic neuropathy, complex regional pain syndrome, opioid refractory cancer pain, SCI pain and postherpetic neuralgia. Such effectiveness alongside unique benefits like reduced dependence on opioids for pain control, decreased nausea, and shortened hospital stay durations for patients sets up lidocaine infusions  to be the future of chronic pain management. 

Here at Ospina Medical, we are excited to offer intravenous lidocaine therapy. Book your initial consultation with Dr. Matthew Kohler today to get started on your pain relief journey. 

Written By: Cherubina Rubannelsonkumar

Edited By: Camden Rowe