Abstract
Opioid abuse is a national epidemic in the United States, where it is estimated that a prescription drug overdose death occurs every 19 minutes. While opioids are highly effective in acute and subacute pain control, their use for treatment of chronic pain is controversial. Chronic opioids use is associated with tolerance, dependency, hyperalgesia. Although there are new strategies and practice guidelines to reduce opioid dependence and opioid prescription drug overdose, there has been little focus on development of opioid-sparing therapeutic approaches. Lidocaine infusion has been shown to be successful in controlling pain where other agents have failed. The opioid sparing properties of lidocaine infusion added to its analgesic and antihyperalgesic properties make lidocaine infusion a viable option for pain control in opioid dependent patients. In this review, we provide an overview of the opioid abuse epidemic, and we outline current evidence supporting the potential use of lidocaine infusion as an adjuvant therapeutic approach for management of chronic pain.
Highlights
Chronic pain is a debilitating condition that frequently requires treatment with high doses of opioids [1]
We provide an overview of the magnitude of the current epidemic of prescription opioid abuse and outline the potential of lidocaine infusion as a viable therapeutic strategy for pain control in opioid dependent patients, where lidocaine infusion has the potential to markedly reduce the dependence on opioids both in the acute and chronic settings
We provide a comprehensive overview of the large body of literature outlining the mechanism of action and role of lidocaine infusion in treatment of pain
Summary
Chronic pain is a debilitating condition that frequently requires treatment with high doses of opioids [1]. Despite the pressing need for formulating a comprehensive response to this problem, responding to concerns regarding opioid prescription patterns places a significant burden on providers involved in treating pain as they strive to balance the need to address the needs of their patients, and at the same time avoiding, over-prescribing, while monitoring opioids misuse and abuse [17] Another recent advance that occurred in 2015 is that all hydrocodone-containing products officially became schedule II drugs, which immediately made it exceedingly more difficult to overprescribe, and prevented mid-level providers for administering these medications without oversight from physicians. The same group showed in a separate study [39] that lidocaine reduced neuropathic pain but did not change dynamic mechanical pain thresholds in non-neuropathic areas Taken together, these results suggest lidocaine exerts a central modality-specific effect rather than a general pain-relieving effect.
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