Chronic pain that comes from RSD or CRPS can interfere with your life to the point that you can’t participate in work or enjoyable activities. Fortunately, researchers and doctors have found several therapies and remedies that can help you return to a relatively pain-free state, allowing you to enjoy your life once more. A lidocaine infusion is often used for this type of pain.
Lidocaine is an anesthetic that helps to block the sensation of pain. You’ve probably received an injection before undergoing dental work or getting stitches for an injury. It worked so well that you couldn’t feel the work being done to your tooth or skin. In the same way, lidocaine, in an intravenous infusion, can help to treat the pain you experience. Your pain might originate from phantom pain after a limb amputation, diabetic neuropathy, or post-herpetic neuralgia.
Can a Lidocaine Infusion Help
Blue Cross of Idaho describes a lidocaine infusion as “one or more courses of IV infusion… administered over several hours or several days.” Your doctor or pain specialist is the best medical professional to decide if this therapeutic approach might be helpful for your pain condition.
A therapeutic lidocaine infusion works by desensitizing the pain pathways in both the central and peripheral nervous systems. Doctors have relied on sympathetic ganglion blocks with lidocaine for years as they treat chronic pain conditions such as RSD or CRPS. Treating chronic pain using this approach is different from using a continuous subcutaneous or IV infusion.
Your pain specialist may choose to give you an intravenous anesthetic medication using a sub-anesthetic dosage after giving you a bolus injection, or a large dose, of lidocaine to bring the concentration of the drug in your bloodstream higher. Once he has achieved this effect, the sub-anesthetic doses help to maintain a constant level of medication in your body, thus relieving your pain.
Pain Relief with a Lidocaine Infusion
Patients who receive a lidocaine infusion can experience a significant level of pain relief. On the RSD Alert website, one patient reports a 70% reduction in pain after approximately two months of treatment. (See RSD Alert website) Because of RSD in the left arm now moving into the left back, this patient has experienced “severe” flare-ups of pain related to weather changes, such as wind speed and humidity, and she has been prescribed lidocaine patches. Her doctor helps her position the patch so she receives the most optimal effects on her RSD symptoms. She prefers the lidocaine treatment over her previous medications, which made her nauseated and affected her ability to think and function. She does have to combine the patches with her oral medications, and is now able to function more normally.
Your doctor may use a sympathetic block to prevent sympathetic nerve impulses from reaching the limb affected by RSD. When they choose to use lidocaine, it can affect your skin by causing flushing, warming your skin, and preventing your limb from sweating. You’ll know that the sympathetic block has been successful when your pain symptoms begin to go away after half an hour.
Your doctor knows the block is successful when you develop what is called the ipsilateral Horner Syndrome. Once the pain impulses have been blocked, you can begin physical therapy. The interruption of pain will last for only a few hours, but the positive benefits may last for much longer, as long as several days, according to the Medscape website. (See Medscape website) When you begin, you can expect to undergo one to two blocks per week, for an average of four to five blocks in total, before receiving permanent relief.
Precautions of a Lidocaine Infusion
If you and your doctor decide that a lidocaine infusion could be an appropriate therapeutic treatment, you do need to be watchful of several adverse effects. These include:
– Sleepiness
– General fatigue
– Dizziness
– Respiratory depression
– Tinnitus
– Muscle twitching
– Headache
– Periorbital and limb numbness and tingling
– Nausea and vomiting
– Tremors
– Blood pressure and pulse changes
Severe adverse effects might include:
– Arrhythmias
– Psychosis
– Seizures
– Loss of consciousness
– Confusion
– Death
For this reason, your doctor will want to make sure that you have a normal conduction on an ECG. You should also have normal serum electrolyte concentrations in your blood. You don’t run the risk of cardiac arrhythmias. If you have been diagnosed with a heart condition, your doctor will let you know that you might not be a good candidate for a lidocaine infusion – it can slow your heart rhythm.
Not all Respond to a Lidocaine Infusion
For the patient with RSD who experienced a 70 percent reduction in pain symptoms, her side effects were a barely noticeable headache and slight nausea. She experienced a greater need to sleep.
Not all patients will respond to therapeutic lidocaine infusion. Because RSD is an unpredictable condition and controlled treatment trials are few in number, therapy and treatment rely on the doctor’s specialty. Especially when the origin of RSD in the individual patient is not known. Doctors may not know if lidocaine infusion will work – all they can do is try the treatment. Early treatment is critical and must be started before you have reached what is called the “chronic fibrotic” stage. The severity of your condition can be controlled and reduced with early prophylactic therapies, including the immediate and aggressive movement of the affected limb, followed by passive and then active range-of-motion physical therapy.
References:
https://www.bcidaho.com/providers/medical_policies/pd/mp_50116.asp Blue Cross of Idaho: Intravenous Anesthetics for the Treatment of Chronic Pain
https://www.rsdalert.co.uk/drugs/Lidocaine.htm RSD Alert: Lidocaine
https://emedicine.medscape.com/article/334377-treatment Medscape: Reflex Sympathetic Dystrophy Treatment & Management