Title:

Efficacy and Tolerability of Intravenous Lidocaine Versus Gabapentinoids in Chronic Neuropathic Pain: A Retrospective Cohort Study

 

Introduction:

● Neuropathic pain is difficult to manage and is rising in incidence, creating a significant healthcare burden [1]

● First-line medications like gabapentinoids deliver inconsistent analgesia and are often poorly tolerated [1]

● Lidocaine, a sodium channel blocker typically used as a local anesthetic, has shown promise when used intravenously for the treatment of neuropathic pain, but comparisons with the standard of care remain limited [2,3]

 

Methods:

● We conducted a retrospective cohort study of neuropathic pain patients at the Columbia University Pain Clinic between January 1st, 2020, and March 1st, 2025

● 20 patients who received lidocaine infusions were compared with 20 patients who received gabapentinoids

● Outcomes included:

      ○ Greatest pain reduction reported within 12 months of beginning treatment

      ○ Adverse medication effects

● Patients also taking opioids, TCAs, or SNRIs were excluded

 

Results:

● Patients’ largest pain reductions were significantly greater in patients receiving lidocaine infusions compared to patients receiving gabapentinoids (54% vs 18%, p=0.006)

● Patients taking gabapentinoids reported medication-related side effects at a rate significantly higher than patients receiving lidocaine infusions (7/20 vs 1/20, p=0.04)

● Side effects most frequently reported in the gabapentinoid group included fatigue and dizziness

 

Discussion:

● Our study demonstrates the potential utility of intravenous lidocaine as an effective chronic neuropathic pain therapy

● We found that patients receiving lidocaine infusions experienced nearly 3-fold greater pain reductions and reported fewer side effects

● The favorable adverse effect profile observed with lidocaine addresses a critical clinical need, as poor tolerability remains a major limitation of first-line therapies. CNS-related side effects of gabapentinoids were not observed in lidocaine infusion patients

● Our results align with those of recent studies suggesting lidocaine provides analgesia through peripheral sodium channel blockade and central modulation of neurotransmitter activity [4]

 

Limitations:

Our investigation has the following limitations:

    ● The retrospective nature of our study

    ● The small size of our population and the lack of multiple clinical sites

    ● The exclusion of patients taking opioids, TCA’s, and SNRIs

 

Future directions:

Our investigation motivates additional work in the following areas:

    ● Larger, prospective studies comparing lidocaine infusions to all standard of care treatment for neuropathic pain

    ● Mechanistic studies to elucidate the exact mechanisms by which intravenous lidocaine treats chronic neuropathic pain

    ● Studies comparing lidocaine infusion protocols

 

References:

[1] Quintero, G.C. (2017). Review about gabapentin misuse, interactions, contraindications and side effects. Journal of Experimental Pharmacology, 13–21.

[2] Tremont-Lukats, I.W., et al. (2006). A randomized, double-masked, placebo controlled pilot trial of extended IV lidocaine infusion for relief of ongoing neuropathic pain. The Clinical Journal of Pain, 22(3), 266–271.

[3] Kim, Y.C., et al. (2018). Efficacy and safety of lidocaine infusion treatment for neuropathic pain: A randomized, double-blind, and placebo-controlled study. Regional Anesthesia & Pain Medicine, 43(4), 415– 424.

[4] Yang, X., et al. (2020). A review of the mechanism of the central analgesic effect of lidocaine. Medicine, 99(17), e19898.