Can Topical Lidocaine Help Solve Chronic Neck Pain?

January 11, 2024

Written by Christopher Thom

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In this randomized trial of patients with chronic neck pain, patients who received lidocaine patch treatments had an equivalent pain response to patients who received placebo patches.      

We all wanted this to work…..  
This RCT enrolled 76 patients who had chronic neck pain > 3 months of duration, were age 18 to 90, and had an average pain score > 4/10 for the week prior to enrollment. Study design was a randomized crossover trial, wherein one group received lidocaine patches first – followed by placebo, while the other received placebo followed by lidocaine. There was a one week washout period between the crossover arms. Lidocaine and placebo patches were identical in appearance and size. They were applied in a 12 hours on-off fashion.

Demographics and baseline outcomes measures were not significantly different between the treatment groups. The primary outcome measure was reduction in average neck pain score (0-10). The lidocaine treatment produced a median change in pain of -1 (IQR -2 to 0), while the placebo treatment resulted in a median change in pain of -0.5 (IQR -2 to 1), p=0.17. The authors looked at a variety of other outcome measures, including worst neck pain rating, degree of insomnia from pain, pressure pain threshold, and patient global impression of change. Unfortunately, there were no statistically significant differences between placebo and lidocaine within each of these outcomes.

How will this change my practice?
In a practice environment where we are all trying to curb the utilization of opioid medications, topical lidocaine for chronic pain represents an attractive option. Side effects in this trial were minimal, and the patches carry an excellent safety profile. And while this trial clearly showed that lidocaine and placebo patches were equivalent, there was pain reduction with the usage of lidocaine patches. Given this, it remains a reasonable option to try for patients with chronic neck pain, though one should understand that the benefits are no greater than placebo.   

Source
Multicenter, Randomized, Placebo-Controlled Crossover Trial Evaluating Topical Lidocaine for Mechanical Cervical Pain. Anesthesiology. Published online December 11, 2023. doi:10.1097/ALN.0000000000004857.